SayPro Registration Form A basic form capturing participant details and confirming enrollment

SayPro Registration Form

Participant Details & Enrollment Confirmation

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Personal Information:

1. Full Name:
   • First Name: ____________________
   • Last Name: ____________________
2. Date of Birth:
   • MM/DD/YYYY: ____________________
3. Gender:
   • ☐ Male
   • ☐ Female
   • ☐ Non-Binary
   • ☐ Prefer not to say
   • ☐ Other: _______________________
4. Email Address:
5. Phone Number:
   • Mobile: ________________________
6. Emergency Contact Name:
7. Emergency Contact Phone Number:

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Address Information:

8. Street Address:
9. City:
10. State/Province:

11. Postal Code:

12. Country:

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Health and Fitness Information:

13. Do you have any medical conditions we should be aware of?

• ☐ Yes
• ☐ No
  If yes, please provide details:

14. Are you currently taking any medications?

• ☐ Yes
• ☐ No
  If yes, please provide details:

15. Have you participated in any extreme sports before?

• ☐ Yes
• ☐ No
  If yes, please list:

16. Fitness Level:

• ☐ Beginner
• ☐ Intermediate
• ☐ Advanced

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Event Selection:

17. Which extreme sport activities are you interested in participating in?

• ☐ Bungee Jumping
• ☐ Skydiving
• ☐ Zip-Lining
• ☐ Rock Climbing
• ☐ Paragliding
• ☐ BASE Jumping
• ☐ Other: _______________________

18. Preferred Date for Participation:

• MM/DD/YYYY: ____________________

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Emergency Waiver and Consent:

19. By checking the box below, I acknowledge that I have read and understood the risks involved in participating in extreme sports. I confirm that I am in good health and capable of participating in the selected activities. I hereby waive any and all liability against SayPro, its affiliates, and instructors.

• ☐ I Agree

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Enrollment Confirmation:

20. Enrollment Fee:

• Total Amount: $_____________

21. Payment Method:

• ☐ Credit Card
• ☐ Debit Card
• ☐ PayPal
• ☐ Bank Transfer
• ☐ Other: _______________________

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Consent to Photography & Media Release:

22. Do you consent to being photographed or recorded for promotional or training materials?

• ☐ Yes
• ☐ No

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Signature:

23. Signature of Participant:

24. Date:

• MM/DD/YYYY: ____________________

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For Office Use Only:

• Enrollment Status:
  • ☐ Confirmed
  • ☐ Pending Payment
  • ☐ Not Confirmed
• Payment Received:
  • ☐ Yes
  • ☐ No
• Instructor Assigned:

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Thank you for registering! You will receive a confirmation email with additional details about your upcoming extreme sports experience soon.