• Parental/Guardian Consent Form

  • To complete this Parental/Guardian Consent Form, you will need on hand:

    • Laptop/Computer available – you may need to upload documents
    • Key Contact Numbers, Address and Email Details
    • Digital Copies of Relevant Medication Details/Medical/Other Management Plans
    • Child/Young Person Drop-off/Pick-up arrangement plans

  • Child or Young Person’s Details

  • Date of birth*
     / /
    2 digit day, 2 digit month, 4 digit year
  • Assigned sex at birth*
  • Pronouns
  • Gender identity
  • Does the child/young person identify as Aboriginal/Torres Straight Islander?

  • Parent/Guardian Contact Details

  •  -

  • Alternative Emergency Contact

  •  -

  • Health or Medical Conditions & Management Plans

  • Does your child/young person have any health or medical conditions and/or management plans? Aikido Victoria would like to know to better support their learning and/or training*
  • Please select all applicable special health considerations
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  • Neurodiversity Conditions & Management Plans

  • Does your child have any neurodivergent conditions which might affect their ability to learn Aikido? Aikido Victoria would like to know to better support their learning and/or training*
  • Please select all applicable neurodiversity options
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  • Psychosocial Conditions

  • Does your child have any psychological/social conditions which might affect their ability to learn Aikido (e.g. anxiety)? Aikido Victoria would like to know to better support their learning and/or training*

  • Medications

  • Is your child/young person taking any prescribed drug? Especially any that may impair reaction time or judgement?*

  • Past Martial Art or Physical Activity Experience

  • Has your child or young person participated in another martial art, sports or other physical activity (e.g. gymnastic, dance)?*
  • Has your child/young person ever been excluded from Martial Arts or other physical activities in the past?*

  • Collect/Pick-Up Details

  • Authorised list of others who can collect/pick up the child/young person

  • Aikido Victoria may check on my behalf that my child/young person is collected by only approved persons, and that on arrival, the person may be asked for proof of identification.

  • I authorise my children/young people to make their own way home*

  • Safeguarding Children and Young People Code of Conduct

  • All parents/guardians must sign the Code of Conduct before completing this form.

  • Declaration of Disclosure & Understanding

  • I hereby certify that I have completed the form and all the information contained in respect of the child/young person is true and accurate to the best of my knowledge.

    I declare that I have read and understood the terms of training detailed in this form, including only taking photos, videos or reels of my own children/young people under my care, and collection/pick-up arrangements.

    I authorise Aikido Victoria to consent on my behalf, where it is impractical to communicate with me or with the emergency contacts listed in this form, for my child/young person to receive medical or surgical treatment and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child/young person as deemed necessary and agree to meet any medical or hospital expenses incurred.

    If I did not understand the terms, conditions and rules, then I have requested an independent person to explain them to me. I also acknowledge with my signature my agreement with what is been concurred in this form.

  • Date*
     / /
    2 digit day, 2 digit month, 4 digit year
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