2021 Club Membership Registration Form

2021 Club Membership Registration Form

Complete the form below to sign up for our membership service.
Athletes Name *

First Name Last Name
Athletes Mobile Number: *

Area Code Phone Number
Athletes Birth Date: *

Month Day Year
Athletes Age as of Dec 31 2021 *
Athlete address (Suburb only): *
How did you hear about us? *

Social Media Google/Search Engine Event (Allstar Competitions) KLD Current or Past PA Athlete
If referred by a current or past PA Athlete please let us know who below so we can thank them!
2021 Team Confirmation

Based on your allocation post placements, which teams will you be signing up for in 2021.
CHEER

GG's (Jnr 1) Lady Luck (Snr 1) Spark (Snr 2) Black Magic (Snr 3) Angels (Open 3) Lady Clovers (Snr 4) Perfection (International 6)
In 2021 Pure Allstars will be offering the following dance classes, restructured slightly to the 2020 program. Please select your age group and preferred style/s for next year.
DANCE

Junior Lyrical (13 years and under*) Senior Lyrical (14-17 years) Open Lyrical (18 years+) Junior Jazz (13 years and under*) Senior Jazz (14-17 years) Open Jazz (18 years+) Junior Pom (13 years and under*) Senior Pom (14-17 years) Open Pom (18 years+) Junior Hip Hop (13 years and under*) Senior Hip Hop (14-17 years) Open Hip Hop (18 years+)
*Note- Official AASCF age brackets vary slightly to the above.

Youth- 12 years and Under

Junior- 15 years and Under

Senior- 18 years and Under

Open- 14 years minimum age.

Depending on numbers, you/your daughter might be placed on a different aged team.

ie. If we have a group of 14 and 15 year olds we might form a Junior team rather than a Senior team.
Parent/Guardian Contact

This section only needs to be completed if information provided in 2020 Registration form has changed.
*

First Name Last Name
Parent/Guardian #1 Name *

First Name Last Name
Email *
Mobile Number: *

Area Code Phone Number
Parent/Guardian #2 Name *

First Name Last Name
Parent/Guardian #2 Email *
example@example.com
Parent/Guardian #2 Mobile Number *

Area Code Phone Number
Medical Details

This section only needs to be completed if information provided in 2020 Registration form has changed.
Ambulance Cover *

Yes No
Bandaid Allergy *

Yes No
If you wear lenses *

Glasses Contact lenses
Medication or Allergies
If Applicable
Other Medical History, Areas of concerns
If Applicable
Private Health Fund Name & Number *
If Applicable
"FORMS TO RETURN"

The following can be referred to at the back of the club handbook. We do NOT require you to complete the forms manually and return them.
Competition Availability

1) Recreational Competitive: Athletes to attend at least 1 competition 2) Semi-Competitive: One Competition Absence allowed (with prior approval) 3) Elite-Competitive: No Competition absences allowed
Any competitions you cannot do?
If Applicable
Waiver
I, the undersigned parent, legal guardian, or I, myself do hereby grant permission for my daughter/myself to participate in any 2021 Pure Allstars practice/event. I have read and agree to the details outlined in the handbook. I further acknowledge and understand and agree that by participating at Pure Allstars there is a possibility of physical illness or injury (minimal, serious, and catastrophic) and that my daughter/myself will be assuming the risk of such injury by participating. I authorize any representative of the Pure Allstars party to consent and authorize any medical attention, treatment or administration of drugs by qualified and licensed medical personnel for my daughter/myself, which may become necessary.I understand I will be notified as soon as possible in the event of an emergency. I understand and agree that all expenses of such treatment are my responsibility. I agree to protect, defend and indemnify Pure Allstars, including its staff, employees and sponsors from and against any and all claims, demand, losses, suits, liabilities, costs, or other damages including court costs and attorney’s fees, arising from any injury to, or death of daughter/myself, the undersigned, or any other persons or damage to or destruction of property arising out of or in connection with any damage to third parties occasioned by, incident to, arising out of, or in connection with my daughter's participation. I understand that Pure Allstars produces promotional material about the program. I hereby grant Pure Allstars, the right to photograph and/or videotape my daughter/myself and utilize my daughter's/my face, likeness, voice and appearance as parts of the advertising and promotion of the program. By signing this document you are agreeing to adhere to the points above. Athletes are unable to participate in the program without the required signatures. *

I have read, understood, and accepted the rules for membership.
Payment Details

Card listed will be used for the February & March Membership Payment + Registration.
Payment Option *

Credit card (no AMEX) Invoice (card details still required for initial bio-monthly payment)
Credit Card Details *
PAYMENT terms and conditions: 1) I understand if paying Annually, the entire fee will be charged upon this form being received. 2) I understand if paying by credit card, my credit card (details as above) will be charged the month prior to 1st month of payment beginning January 2021, ending September 2021. February & March payments are made upon sign up.February & March payments will be deducted as the form is received. 3) The credit card listed above will only be used for the payment of all monthly tuition, uniform & competition entry fees unless instructed otherwise by the cardholder. 4) If paying another way, invoices will be sent out in Mar, May, Jul and Sep. Invoiced fees must be paid within 2 weeks. A $50 late fee is added for overdue payments. Invoices will be sent to the email address provided on this form. 5) I understand the fees are prorated (refer to “Fees” in handbook) and there is a late start up fee of 1 month payment and an early exit fee of 2 months payment. All fees are non-transferrable & non-refundable. *

I have read, understood, and accepted the terms for payments.
Signature *

Clear
*Forms must be returned by the 10th of January 2021. All forms returned after the 10th of January 2021 will incur a $50 late admin processing fee.
Should be Empty:

2021 Club Membership Registration Form

2021 Team Confirmation

Parent/Guardian Contact

Medical Details

"FORMS TO RETURN"

Competition Availability

Waiver

Payment Details