2023 RECREATIONAL PROGRAMS REGISTRATION ENROLMENT FORM

TERM 1 - Classes that are highlighted in RED are Fully Booked.

NO MORE BOOKINGS CAN BE ACCEPTED FOR THESE CLASSES!

If the class you are wanting is listed below as being Fully Booked and you would like to be added to our Waitlist Register, click on the link and complete the form.

WAITLIST REGISTER

	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY
8:00am						Boys Jnr Rec Girls Jnr Rec Girls Snr Rec
9:15am						Girls Jnr Rec Girls Snr Rec
10:15am						Freestyle
3:45pm	Boys Jnr Rec Girls Jnr Rec *Girls Snr Rec*	Boys Jnr Rec Girls Jnr Rec *Girls Snr Rec*	Boys Jnr Rec Girls Jnr Rec Girls Snr Rec	Boys Jnr Rec Girls Jnr Rec *Girls Snr Rec*	Boys Jnr Rec Girls Jnr Rec Girls Snr Rec
5:00pm	Boys Snr Rec Girls Jnr Rec Girls Snr Rec	Boys Snr Rec Girls Jnr Rec Girls Snr Rec	Boys Jnr Rec Girls Jnr Rec Girls Snr Rec	Boys Jnr Rec Girls Jnr Rec Girls Snr Rec	Boys Jnr Rec Girls Jnr Rec Girls Snr Rec
6:15pm	Freestyle	Freestyle	Freestyle	Freestyle	Freestyle

Child's First Name*

First Name

Child's Last Name*

Last Name

Gender*

MaleFemaleOther

Date of Birth*

DayMonthYear

KINDERGYM - Select Day & Time

JUNIOR RECREATIONAL - Select Day & Time (Born 2018 & 2017)

SENIOR RECREATIONAL - Select Day & Time (Born 2016 & 2015)

FREESTYLE - Select Day & Time (Born 2014 or earlier)

	MONDAY	TUESDAY GIRLS ONLY	WEDNESDAY	THURSDAY GIRLS ONLY	SATURDAY
10:30AM - 12:00PM (SAT ONLY)
6:15PM - 7:45PM (MON-FRI)

TEENGYM - Select Day & Time (12 - 15 Years)

	WEDNESDAY
6:15PM - 8:15PM (WED ONLY)

ADULT STRENGTH & CONDITIONING

	TUESDAY	FRIDAY
9:15AM (FRIDAY ONLY)
7:30PM (TUESDAY ONLY)

TERM 1 2023 Fees and Charges (includes Building and Equipment Levy)

Term 1 (10 week Term)

Tuesday - Thursday

Term 1 Public Holiday effected classes (9 week Term)

Monday 6th March- Labour Day
Friday 7th April- Good Friday
Saturday 8th April- Easter Saturday

2&3 Year Old Kindergym

$194.00 + Registration Fee (10 week Term)
$177.00 + Registration Fee (9 week Term)

4&5 Year Old Kindergym

$249.00 + Registration Fee (10 week Term)
$224.00 + Registration Fee (9 week Term)

Junior & Senior Recreational

$249.00 + Registration Fee (10 week Term)
$224.00 + Registration Fee (9 week Term)

Freestyle

$319.00 + Registration Fee (10 week Term)
$287.00 + Registration Fee (9 week Term)

TeenGym

$389.00 + Registration Fee (10 week Term)

Adult Strength & Conditioning

$249.00 + Registration Fee (10 week Term)
$224.00 + Registration Fee (9 week Term)

2023 Annual Registration Fees

Every athlete must pay an Annual Registration Fee each year. This fee is to cover your insurance and registration to NDGC & Gymnastics Australia.

Fees must be paid in full prior to the commencement of you/ your child's first class for gym floor entry.

The Annual Registration fee will be included on your Term 1 Invoice.

KinderGym - Annual Registration Fee - $80.00 (per child)

Junior & Senior Recreational, Freestyle & TeenGym - Annual Registration Fee - $120.00 (per child)

Adult Strength & Conditioning - Annual Registration Fee - $30.00 (per person)

2023 Class Timetable

Parents Full Name*

Email*

Mobile Phone Number*

Address*

Street Address

Street Address Line 2

Suburb

Postcode

DISCLAIMER - We, the Pivotal Gymnastics Management, members of the body corporate (hereinafter referred to as “PGM”), advise that the learning of and participating in the sport of gymnastics, by its very nature, contains an element of risk. Whilst all due care and caution is undertaken to ensure the safety and wellbeing of gymnasts under the care of PGM, no liability is accepted for injury sustained whilst under that care. The personal information provided by you on this form will be used in accordance with our Privacy Policy. To obtain a copy of our Privacy Policy, enquire about any privacy issue, or make a request for access to information, please contact the Business Manager at PGM.*

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 behaviour 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

Preferred Dr

Dr's Phone

Medicare Number

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 thirty (30) 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 statementNO, 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 minorsNO, I do not consent to the photo release of minors

How did you hear about us?*

	Social Media	School	Returning Member	Friends/ Family
PLEASE SELCT

Signature*

Clear

	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY)
KINDERGYM 2Years 9:15AM - 10:00AM (MON-FRI)
KINDERGYM 3 Years 10:00AM - 10:45AM (MON-FRI)
KINDERGYM 4&5 Years 11::00AM-12:00PM (MON-FRI)
KINDERGYM 4&5 Years 12::00PM-1:00PM (MON-FRI)
KINDERGYM 4&5 Years 10:30AM - 11:30AM (SAT ONLY)
KINDERGYM 4&5 Years 12:30PM - 1:30PM (SAT ONLY)
KINDERGYM 4&5 Years 1:30PM - 2:30PM (SAT ONLY)

	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY
8:00AM - 9:00AM (SAT ONLY)
9:15AM - 10:15AM (SAT ONLY)
3:45PM - 4:45PM (MON-FRI)
5:00PM - 6:00PM (MON-FRI)

	MONDAY	TUESDAY	WEDNESDAY	THURSDAY	FRIDAY	SATURDAY
8:00AM - 9:00AM (SAT ONLY)
9:15AM - 10:15AM (SAT ONLY) NO Boys classes offered at this time
3:45PM - 4:45PM (MON-FRI) GIRLS ONLY
5:00PM - 6:00PM (MON- FRI)