2022 REGISTRATION ENROLMENT FORM 9 -13 YEAR OLDS FREESTYLE GYMNASTICS PROGRAM
(Born 2013 or earlier) Please complete one form per child
Are you a returning member from 2021?
YES, I am a returning member
NO, I am a new Member
Date of Birth
Select Day Option 1
6:15pm to 745pm
10:30am to 12noon
Select Day Option 2 (if we cannot accommodate your first option)
6:15pm to 7:45pm
10:30am to 12noon
We will do our very best to meet your request.
Mobile Phone Number
Street Address Line 2
I have read and understood the above disclaimer
Medical Information - Yes - Please provide details of any medical, sport injuries, physical or intellectual conditions that may have bearing on your child's ability, safety or behavior in class. (ie: epilepsy, asthma, growth related). If your child suffers from any allergies or is on any medication or currently in treatment for injuries that we should be made aware of. If not - Please type No
Emergency Contact Name
Emergency Contact Number
Relationship to child
Name of Private Health Fund
APPLICATION FOR REGISTRATION - I/ We the undersigned applicant, having read the conditions outlined, in addition to the DISCLAIMER, and agreeing to abide by the Constitution, Board Resolutions and Club Rules in force at any time, hereby apply for registration to the Pivotal Gymnastics Management. Furthermore, I authorise my child’s coach to obtain any medical assistance that is deemed necessary for myself/ my child, in the case of an emergency, and agree to pay all medical expenses incurred through the emergency. The PGM may at its discretion commence proceedings or engage debt collectors to recover fees outstanding for a period in excess of sixty (60) days. The expense of debt recovery will be a cost to the member or former member and will be added to the amount of any outstanding fees. I agree to the above statement
YES, I agree to the above statement
NO, I disagree to the above statement
Photo Release for Minors (if under 18yrs)Northern Districts Gymnastic Club has my permission to use my or my child's photograph publicly to promote the gym. I understand that the images may be used in print publications, presentations, websites and social media.
YES, I consent to the photo release of minors
NO, I do not consent to the photo release of minors
How did you hear about us?
Friends or Family
Should be Empty: