Gym Health Waiver

To register to our gym please fill out the following medical form

First Name

Email Address

Last Name

Date of Birth (Optional)

Sierra Leone Passport Carrier

No

Yes

Current Position?

Geology

Mining

Processing

Engineering

Logistics

Finance

Administration

Human Resources

Information Technologies

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Code

Phone

Thanks for submitting!

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