Mulgoa Valley Physie Club Membership Form

Mulgoa Valley Physie Annual Membership

Complete the form below to become a member of Mulgoa Valley Physie for 2023.
Parent Name*

First NameLast Name
Family E-mail*
example@example.com
Main Contact Number:*
Family Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Member 1 Name

First NameLast Name
Member 1 Birth Date:

DayMonthYear
Member 1 Age Group/Section for 2023. For all Junior members this is your age as at 31st August.

EP Petites (3-4 years)5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years12-14 Years15-16 YearsIntermediate Seniors (aged 17-20yrs)Open Seniors (aged 21yrs+)Extended Ladies (18yrs+)Ladies (aged 21yrs+)
Member 2 Name

First NameLast Name
Member 2 Birth Date:

DayMonthYear
Member 2 Age Group/Section for 2023. For all Junior members this is your age as at 31st August.

EP Petites (3-4 years)5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years12-14 Years15-16 YearsIntermediate Seniors (aged 17-20yrs)Open Seniors (aged 21yrs+)Extended Ladies (18yrs+)Ladies (aged 21yrs+)
Member 3 Name

First NameLast Name
Member 3 Birth Date:

DayMonthYear
Member 3 Age Group/Section for 2023. For all Junior members this is your age as at 31st August.

EP Petites (3-4 years)5 Years6 Years7 Years8 Years9 Years10 Years11 Years12 Years12-14 Years15-16 YearsIntermediate Seniors (aged 17-20yrs)Open Seniors (aged 21yrs+)Extended Ladies (18yrs+)Ladies (aged 21yrs+)
Do any members have any medical conditions we need to be aware of? (Injuries, Illnesses, Allergies)
Where did you hear about us?

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Membership Rules & Fees
1. Membership is available to anyone 2 years of age or older.

2. I will be required to hire or purchase an individual Leotard and from 7 years up may also be required to purchase a team leotard.

3. If I/my child enters a team competition I/they will be required to attend extra team practises.

4. All Term Fees are to be paid in FULL by week 2 of each term (unless other arrangements have been organised with Nicole).

5. All fees are non-refundable.

2023 Annual Mulgoa Valley Membership Fee
- EP Petites (3-4yrs) = $240
- 5 Years - Ladies = $460
Annual Fee Covers
- Your Club membership fee
- All MVP run classes throughout the year
- Entry to all interclubs attended by MVP and
- Entry for all family & friends at our end of year Showcase
*

I have read, understood, and accepted the rules for membership.
First Aid Treatment
*

As a member of Mulgoa Valley Physical Culture, I agree for all those listed on this form, to be administered first aid in the event of an accident or illness if required.
Photography Consent
I hereby give permission for the Edith Parsons School of Physical Culture and the Mulgoa Valley Physical Culture Club and their delegated photographers to photograph my child/myself/my family in a group or individually at events being held and I am aware that such Photographs may be used for promotional purposes.
*

I have read, understood, and accepted the Photography Consent for membership.
Personal Injury Waiver
I understand that Public Liability Insurance is included in the Registration Fee paid to the Edith Parsons School of Physical Culture BUT personal injury to my child or myself while undertaking Physical Culture activities is not covered.

I understand that during physical culture activities incident and injuries may happen and I acknowlede this warning of the injury risks involved.

To the extent permitted by the law, I assume the risks of my child or myself undertaking Physical Culture Activities and I agree to uphold harmless the Edith Parsons School of Physical Culture and Mulgoa Valley Physical Culture Club against any medical, hospital or ambulance expenses incurred in the treatment of my child or myself relating to personal injury sustained.
*

I have read, understood, and accepted the Personal Injury Waiver for membership.
Thank you for wanting to be a part of the Mulgoa Valley Physie family in 2023. We can't wait for a fantastic year!
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Mulgoa Valley Physie Annual Membership

Membership Rules & Fees

First Aid Treatment

Photography Consent

Personal Injury Waiver