Come and Try Nippers

Come and Try Nippers Registration

2024/25 Season
Child's Details
Name*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Child must be a minimum of 5 years old
Gender*

MaleFemaleNon-binary
Address*

Street Address

Street Address 2

SuburbState

Post Code

How would you rate your child's confidence in the ocean water environment?*

1

2

3

4

5

1 is No Confidence, 5 is Extremely Confident
Which option best describes your child's swimming ability?*
Does your child attend swimming lessons?*
Please advise which Swim Centre*

Medical
Does your child have any medical condition/s or health problems that require disclosure?
Please provide details of the the medical condition/s or health problems*
If a medical emergency could occur, please provide any further relevant information:
Precautions to avoid an emergency
How to recognise an emergency
Emergency treatment required
Does your child require additional assistance to participate in the program?*
Please advise the assistance required*
Does your child take any prescribed medication (including inhalers)?*
Is this medication required to be brought to the event?*
If YES, a parent/guardian MUST be in attendance to administer the medication.i
Please name any prescribed medication (including inhalers) taken by your child:
Medication Name(s)
When Taken:
Dose:
How Taken:
Side Effects:
*Note: Any medication needed should be available during activities, with written notes of your child’s name, medication, dose, etc.

Parent/Guardian Details
Name*

First NameLast Name
Relationship to child*
Mobile*
Email*
example@example.com
PLEASE READ CAREFULLY

By signing on behalf of my child, I:
a) agree to waive and release, and will release, the Club and it's personnel from any claims including but not limited to any negligent or reckless act or omission, that I may have, or may have had, but for this release arising from or in connection with my participation in any Surf Life Saving activity conducted by the Club and/ or SLSA;
b) agree that I/my child(ren) are not covered by any Personal Accident Injury Insurance while participating in Surf Life Saving activites conducted by the club;
c) consent to the appointed doctors, coaches, staff and other officials of the Club to provide first aid to my child and if required deliver my child for treatment to the nearest operating and available medical facility if they are injured as a result of any participation in Surf Life Saving activity conducted by the Club and/or SLSA; and
d) consent to the Club and SLSA, using my and my child's name, image and likeness and also my child's performance in or of any Surf Life Saving activity at any time to promote the Objects of the Club and/or SLSA, by any form of media. I waive any rights I might have to or in such use of my and my child's name, image or likeness by the relevant SLS organisation. By providing yours and your child's personal information to SLSA, you consent to it's use, storage and disclosure in accordance with SLSA Privacy Policy (available at sls.com.au)
WARNING: SLS Activities can be inherently dangerous. I acknowledge that I or my child is exposed to certain risks during SLS Activities including but not limited to physical exertion, contact with surf life saving equipment, body contact, surf, sea, tidal, and weather conditions and exposure to potential or actual conditions, infections and/or other ilnesses. I acknowledge that accidents can and often do happen which may result in me or my chlld being injured or even killed, or my or my chlld's property being damaged. I have voluntarily read and understood this warning and accept and assume for myself and my child the inherent risk of my child participating is SLS Activities. SLS Activities means performing or participating in any capacity in any activity, event or function organised by an SLS Organisation.
Parent/Guardian Signature*

Clear
Date*

DayMonthYear
Should be Empty:

Come and Try Nippers Registration

Child's Details

Medical

Parent/Guardian Details