2025 Member Registration Form

2025 Member Registration Form

Eastlakes Physical Culture Club
Fill in the information below to join the most exciting and fastest growing club!
Participants Details:
Full Name*

First NameLast Name
Date of Birth

DayMonthYear
Date
Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age group (the age you are at 31st August 2025)
Is the participant available to commit to a team*
Is the participant available to commit to multiple teams if required?*
Leotard and Skirt size
Parent or Emergency Contact details

When participant is under 18s
Primary Parent Full Name *

First NameLast Name
Parents Phone Number *
E-mail
This is where your invoice and receipts will be sent to
Alternative Emergency Contact (use for under 18s)*

First NameLast Name
Emergency Phone Number*
Are you interested in being an Age Group Manager? *
Are you interested in being in the fundraising committee? *
I understand that Physical Culture presents a risk to the participant. I understand that there is an inherent risk of injury and i agree to assume that risk in order to participate in these activities. The undersigned acknowledges that the participant is in good health and does not have any history of medical or physical condition that would place the participant at risk during participation due to the medical or physical condition.

i agree to pay all necessary fees with Eastlake Physical Culture Club on time or i will be redirected to a debt collectors agency.

I understand that payments have the option of:

1) being paid in full for the year

2) Paid per term

3) Paid per payment plan organised with the committee

If i require an alternative option of payment i will seek this out directly with the Committee to arrange.

I understand that no refunds will be provided, and an exit fee will be payable if i choose to leave the club throughout the year.

I agree that Eastlakes Physical Culture can charge my card on file for any overdue fees.

I do hereby release and forever discharge Eastlakes Physical Culture Club their predecessors and successors, employees, agents and assigns and all other persons, corporations and entities from all claims, expenses, attorney fees and causes of action or suits of any kind or nature associated with the participants involvement with Eastlakes Physical Culture Club.

I understand the Eastlakes Physical Culture Class Fees and Registration Fees for EP Physie are all non-refundable and i agree to pay the required exit fee should i choose to leave the program through the year.
I have read and agree to all terms and conditions

yes, i agree
I hereby give permission for Eastlakes Physie or their delegated photographers to photograph my child/myself/family in a group or individually at events being held by Eastlakes Physie and I am awarethat such photographs may be used for promotional purposes.

Yes, i give permission for all photos to be usedNo i do not give permission for photos to be used in promotional materials
I understand that i need to complete a separate registration to EP Physie and pay the registration fee to ensure i am covered by any insurance before 28/2/2025

Yes i understand
Payment
Payment option for 2025 *
Should be Empty:

2025 Member Registration Form

Parent or Emergency Contact details

Payment