License Application

License Application Form

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Parent (For applicants below 18 years old.)

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PARENT CONSENT

Consent Statement for applicants under 18 years old:

Am the parent/guardian of the above-named (“the minor”) who is under 18 years old.

I have read this document and understand its contents, including the exclusion of liability and assumption of risk, and have explained the contents to the minor. I consent to the minor attending/ participating in the event at his/her own risk.

License Number *

Year Of Issue *

Type *

Authority *

Personal Details

Full Name *

Mobile No *

Nationality *

NIRC/Passport *

Gender *

Email *

Date of birth *

Age

Height (CM) *

Weight (KG) *

Address 1 *

Address 2

Postcode *

State *

Particulars of Current JPJ Driving License

License Number

Expiry

Classes

Particulars of Affiliated Club Membership

Club Name

Membership Number

Emegency Contact

Emegency Contact 1 *

Emegency Contact 2 *

License Category *

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