AMI Health Solutions

01

Account holder

The account holder is responsible for the registration, programme communication and account.

First name

Surname

Identity type

ID / passport number

Mobile

Alternative telephone

Email address

Financial email address (if different)

Programme communication

Add my mobile number to the relevant WhatsApp group Send programme notices by email Add another WhatsApp number

Physical address

Address line 1

Address line 2 (optional)

Suburb

City / town

Country

Province

Postal code

Use a different postal address

02

Participants and programmes

Choose independently for each participant. School programmes do not require parents to select a day or time.

Participant 1

First name

Surname

Preferred name

Date of birth

Gender

Preferred language

Medical conditions, allergies, injuries or participation concernsDo not provide a detailed medical history. AMI will arrange secure follow-up if more detail is required.

Images in the internal school or programme group

Images on AMI social media or public marketing

Programme choicesEach choice belongs only to Participant 1.

Programme 1

Location or school

AMI service

Programme

Can’t find the school or location? Send AMI an enquiry.

03

Emergency contact

First name

Surname

Relationship to participant

Emergency contact mobile

Only participation-relevant health information is requested. AMI will arrange a secure follow-up if further information is needed before participation.

04

Terms, consent and declaration

Add a programme to load the terms and consent sections that apply.

Typed full name (electronic signature)

Date of signing

I confirm that the registration details and programme choices are accurate and complete.

I understand that my typed name is my electronic signature and confirms my agreement to the applicable terms and consent sections.