E-mail: Title: First Name: Middle Initials: Surname: Address: Gender: Date of Birth:

National ID #: Drivers Licence #: Passport #: Payment Term:

Telephone Number Telephone   Type   New No telephone numbers on file. Loading…

Contacts First Name   Surname   Telephone   Type   Alt. Telephone   Type   Relation   New No emergency contacts on file. Loading…

Last Physical Exam:

Allergies Allergen   Remarks   New No allergies on file. Loading…

Illness/Conditions Illness/Condition   Remarks   New No illness/conditions on file. Loading…

Doctors First Name   Surname   Address   Country   Telephone   Type   Alt. Telephone   Type   New No doctors on file. Loading…

Other goals:

Portside Fitness Centre, Barbados Port Inc, its staff and affiliates are only liable to you as set out in this agreement. We do not exclude or restrict our liability for anything which cannot by law be excluded. We are not liable to you in any way for any acts of omissions beyond our control. We may be unable to provide the service to you because of something beyond our control.