Enrollment Form

V.V RYTHMIC ACADEMY ENROLMENT FORM

Name (Participant 1)*

First NameLast Name

Name (Participant 2)

First NameLast Name

Address (Residential)*

Suburb*

Post Code*

Date of Birth*

DayMonthYear

Date of Birth (Participant 2)

DayMonthYear

Gender*

Gender (Participant 2)

Address (Postal)

Suburb

Post Code

Phone (Home)

Home

(work)

(Mobile)

Email*

example@example.com

Parent/Guardian 1 (please print)

Phone (Home)

Home

(Work)

(Mobile)

Parent/Guardian 2 (please print)

Phone (Home)

Home

(Work)

(Mobile)

Please provide details of any medical, physical or intellectual condition that may have a bearing on your child’s ability, safety or behaviour in class.

Is your child on any medication, which we should be aware?

Does your child suffer from any allergies ie. Medical, bee sting etc?

I give permission for my child to be photographed/videoed while participating in any club activities. I consent for the photos/video to be used for publicitiy if required.

YesNo

I give my permission for my child to receive medical/ambulance assistance in case ofemergency and agree to pay such costs incurred.

YesNo

I understand that I may access my child’s personal information withheld by the club upon request

YesNo

I understand a formal registration policy is recorded and is available upon request.

YesNo

The information provided on this form is complete and correct to the best of my knowledge and I undertake to advise the Club promptly of any changes that may occur.

YesNo

I have read and understand this enrolment application and club rules and agree to the terms and conditions stated therein

YesNo

In accordance with the Privacy Amendment (Private Sector) Act (2000), the information contained within this form will be used primarily for matters specifically related to participating in gymnastics and/or if a secondary purpose is related to the primary purpose and one could reasonably expect such use or disclosure. To assist in providing our services, the organisations to which we disclose information include:
Outsourced service providers who manage the services we provide to you, including:
o Gymnastics VIC 2

o Gymnastics Australia
o Insurers
o Sport Education Section (ASC)

Our professional advisors, including our accountants, auditors and lawyers.
Government and regulatory authorities and other organisations, as required or authorised by law. We limit the use and disclosure of any personal information provided by us to such organisations for the specific purpose for which we supplied it. If you choose not to provide personal information, we may not be able to provide you with the services you require, or the level of service on which we pride ourselves.

Participation in gymnastics activities carries with it a reasonable assumption of risk:

As legal guardian of my designated daughter(s), I hereby consent to all daughter(s)participating in this facility's program(s I recognise that potentially severe injuries can occur in any activity involving motion, including pre-acrobatic and related activities including gymnastics and physical activity in general. I understand that it is the express intent of all staff and personnel to provide for the safety and protection of my daughter(s) and, inconsideration for allowing my daughter(s) to use these facilities, I hereby covenant not to sue and forever release this facility, affiliated and partner companies and organisations, property owners and lessors, staff, contractors, subcontractors, teachers, coaches, owners, directors and other members involved in this facility's program(s), from all liability and for any and all damages and injuries suffered by my daughter(s) during instruction, supervision, and/or control during any and all classes or extra activities, including walking groups

Parent/Guardians Signature

Date

DayMonthYear

Gymnastics Club Enrolment Form

Medical History

Terms and Conditions