Trip Consent Form - Alusani Maths and Science Academy

Trip Consent & Indemnity Form

Please complete this form to confirm your participation in an upcoming AMSA trip. A signed copy is kept on file for our records.

Trip *

Trip Details

Participant Name *

Birth Date *

Your Details *

Email Address *

Phone Number *

Parent/Guardian Details *

Full Name *

Home Address *

Home Phone *

Work Phone

Email Address *

Emergency Contact *

Full Name *

Phone Number *

Relationship *

Medical Information

Medical Conditions (if any)

Allergies (if any)

Medical Aid Details (if any)

Terms & Conditions *

Select a trip above to view its terms and conditions.

POPIA Consent *

Signature *

Parent/Guardian Signature *

Learner Signature *