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
Date
Registration Number
Office Use Only
Childs Full Name*

First NameLast Name
Gym Class
Date of Birth*

DayMonthYear
Date
Sex*

MaleFemaleOther
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.*
Home Num
Email*
example@example.com
(Parent/Guardian2) Full Name
Occupation
Address

Address

Street Address Line 2

SuburbState

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

Address

Street Address Line 2

SuburbState

Post Code
Member of Ambulance service or covered by Private Health Fund*

YesNo
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)

EpilepsyDiabetesHepatitis AHepatitis BHeart ProblemsHeart MurmurAsthma / BronchitisHerniaConcussionBlood DisorderAnaphylaxisHave an EpiPen - YesHave an EpiPen - NoADHDASDNoOther
Have you sustained:(please select whichever is applicable)

A fracture in the last 3 yearsA dislocationNo
If yes to fracture please describe where.
If yes to dislocation please describe where.
Do you suffer from (please select whichever is applicable)

Back / Neck painReoccurring pain in any joint with play/practiceOther allergies/disabilitiesNo
If yes to reoccurring pain please describe where.
Please specify other allergies / disabilities here
Marketing Information
Existing Member

YesNo
Where did you hear about MGA
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

Clear
Childs Full Name*
(1) PARENT / GUARDIAN TO SIGN
SIGNED*

Clear
Full Name*
Please Select the type of identification you are using.
ID Number - Drivers Licence Passport etc*
Date of Birth*

DayMonthYear
Date
(2) PARENT / GUARDIAN TO SIGN
SIGNED

Clear
Full Name
ID Number - Drivers Licence Passport etc
Date of Birth

DayMonthYear
Date
MGA TO SIGN:
SIGNED

Clear
Name
Position
Date

DayMonthYear
Date
Click the Submit button to submit this form and take you to our Terms and Conditions of Trade form. If this doesnt happen please contact Admin.
Should be Empty:

MEMBERSHIP FORM

Medical Information

(1) PARENT / GUARDIAN TO SIGN

(2) PARENT / GUARDIAN TO SIGN

MGA TO SIGN: