Registration Form – MMG Performance

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MMG PROGRAM REGISTRATION

Thank you for choosing MMG Performance! Please use this form to register for the program of your choice. After completing the form you will be automatically redirected to our online payment page.

STUDENT INFORMATION

Name

Gender

MaleFemale

Date of Birth

Nationality

Country of Residence

Address

0 /

Phone Number

PARENT/GUARDIAN INFORMATION

First Parent/Guardian

Name

Relationship to Student

Phone #1

Phone #2

Addressif different from student

0 /

Second Parent/Guardian

Name

Relationship to Student

Phone #1

Phone #2

Addressif different from student

0 /

STUDENT MEDICAL HISTORY

Allergies

0 /

Physical Conditions

0 /

Medical Conditions

0 /

Is the student currently taking any prescription medications?

YesNo

If yes, please give specific details

0 /

If there is anything that MMG staff should be aware of that doesn't fall under the above medical questions, please provide specific details

0 /

Please review the enrolment waiverCLICK HERE TO VIEW

I Agree to the Terms of the Waiver

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