Athletics Holiday Clinic

Term 4

Monday 13th October - 15th December 2025
Athlete Information
Athlete's Name*

First NameLast Name
Athlete's Year of Birth*
Sex*

MaleFemale
Parent/Guardian Information
Name*

First NameLast Name
Mobile Number*
Alt. Mobile Number
E-mail*
example@example.com
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Payment method*

Direct DepositCredit Card belowCash on the day
Pay by Direct Deposit BSB; 016080 Account; 590417278

Mondays $190Sprinting Fast T-Shirt Medium $30Sprinting Fast T-Shirt Large $30Sprinting Fast T-Shirt X-Large $30Shoe Bag $10
Where did you here about Junior Sprints?*

Internet searchWord of MouthHoliday ClinicSchool NewsPrivate TrainingFacebookInstagramTikTokOther
I give permission for the above mentioned participants photo to be used by Sprinting Fast on social media and for promotional purposes.*

YesNo
Declaration: [Yes] I, parent/guardian, in the event of an accident or illness suffered by my child, authorise the organisers to obtain, on my behalf, such medical assistance as my child may require. Organisers will not be liable for loss, damage or injury, to property or person, occasioned as a consequence of enrolment of any child or children in any Programs, and I acknowledge the exclusion of liability accordingly.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.