MGA Membership Form

MEMBERSHIP FORM
Important Information.

The Club registration procedure involves three forms; Membership Form, Terms and Conditions of Trade and Fees Policy. All of these forms MUST be read, completely filled in and signed. Failure to do so will result in your membership being delayed and your child being unable to participate in classes. These forms will open in order once you submit the previous form. Please do not exit the procedure until all three forms are completed.
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Registration Number
Office Use Only
Childs Full Name

First NameLast Name
Gym Class
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Sex
Childs School
Previous Gym Club
We require the details of at least one parent/guardian if the Member is under 18 years of age, who will take full responsibility for the Member and guarantee payment.

Parent/ Guardian: (if more than two, please attach a separate sheet)
(Parent/Guardian 1) Full Name
Occupation
Address

Address

Street Address Line 2

SuburbState

Post Code
Mobile Num.
Format: 0000 000 000.
Home Num
Email
example@example.com
(Parent/Guardian2) Full Name
Occupation
Address

Address

Street Address Line 2

SuburbState

Post Code
Mobile Num.
Format: 0000 000 000.
Home Num
Email
example@example.com
Emergency Contact Name
Emergency Contact Phone Number
Format: 0000 000 000.
Medical Information
Doctors Name
Doctors Phone Number
Format: 0000 000 000.
Doctors Address

Address

Street Address Line 2

SuburbState

Post Code
Member of Ambulance service or covered by Private Health Fund
Medicare Number
Private Health Insurance Fund:
Private Health Insurance Number
To maintain a child-safe environment, we require information on any pre-existing medical conditions, injuries, surgeries, or special requirements to ensure a safe and supportive experience for all participants. This enables our coaches to provide appropriate assistance, make necessary training adjustments, and respond swiftly and effectively in case of an emergency.
All medical information is kept strictly confidential and used solely for the participant’s safety and well-being.
Have you had (please select whichever is applicable)

Other
Do you have an EpiPen
What are you anaphylactic to?
Have you sustained:(please select whichever is applicable)
If yes to fracture please describe where.
If yes to dislocation please describe where.
Do you suffer from (please select whichever is applicable)
If yes to reoccurring pain please describe where.
Please specify other allergies / disabilities here
Marketing Information
Existing Member
Where did you hear about MGA
#18642 © Copyright - EC Credit Control 1999 2024
I certify that the above information is true and correct. I understand I am a member of Gymnastics Australia and Gymnastics Victoria and will be bound by all rules, regulations, policies and procedures of these bodies. I have read and understand all the TERMS AND CONDITIONS (overleaf or attached) of Melton Mowbray Gymnastics Club Inc. T/A Melton Gymnastics Academy, which form part of, and are intended to be read in conjunction with this Membership Form and agree to be bound by these conditions, and authorise the use of my personal information as detailed in the Privacy Act clause therein.

CHILD TO SIGN (if 18 years or older)
SIGNED
Childs Full Name
(1) PARENT / GUARDIAN TO SIGN
SIGNED
Full Name
Please Select the type of identification you are using.
ID Number - Drivers Licence Passport etc
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
(2) PARENT / GUARDIAN TO SIGN
SIGNED
Full Name
ID Number - Drivers Licence Passport etc
Error: The Licence number can not be the same as Parent / Guardian 1.

Please change the number.
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
MGA TO SIGN:
SIGNED
Name
Position
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Click the Next Page button to submit this form and take you to our Terms and Conditions of Trade form. If this doesnt happen please contact Admin.
#18642 © Copyright - EC Credit Control 1999 - 2024
Should be Empty:

MEMBERSHIP FORM

Medical Information

(1) PARENT / GUARDIAN TO SIGN

(2) PARENT / GUARDIAN TO SIGN

MGA TO SIGN: