Nedstar – Indemnity Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. Name of child *FirstLastDate of Birth *Please enter as follows (yyyy-mm-dd)School Name / Team *Which Clinic are you attending *SeniorJuniorPhysical Address *Email Address *Parent / Guardian Contact Number *Medical Aid Provider / Hospital PlanMedical Aid / Hospital Plan Number POPI Statement (Do you Agree) *YesNoThe personal information provided in this indemnity form will be used solely for the purpose of fulfilling the obligations under this agreement. The information may be shared with third parties only as required by law or to fulfill the obligations of this agreement. We will take reasonable measures to safeguard your personal information and will retain it only for as long as necessary. You have the right to access, rectify, or erase your personal information at any time by contacting us. By signing this indemnity form, you acknowledge that you have read and understood this POPI (Protection of Personal Information) clause and consent to the processing of your personal information as described hereinName of Consenting Parent / Guardian *Signature Clear Signature Submit