School Holiday Registration Form

Parent Name

First NameLast Name

Email

example@example.com

Child attending Program

Age of child

Gender

NDIS Number and Plan Expiry Date

How is your Child's Plan managed

For Plan Managed - Please include Plan Managers name, email address and contact Phone Number

Child's Primary Disability

Details of any Behaviour management plan or other relevant information

NDIS Funding Support Category (if known)

Primary Emergency Contact

First NameLast Name

Emergency Number

2nd Emergency Contact (only if required)

First NameLast Name

Emergency Number

Does you Child have a pre-existing heart condition or have ever suffered a stroke?

YesNo

Does your child have unexplained pains in chest at rest or during physical activity/exercise?

YesNo

Does your child ever feel faint or have spills of dizziness during activity/ exercise that causes loss of balance?

YesNo

Does your Child suffer from Asthma or had an asthma attack requiring immediate medical attention in the last 12 months

YesNo

Does your child have Diabetes (Type 1 or 2) and finding it hard to control blood glucose levels in the last 3 months?

YesNo

Do you have any other medical conditions that may make it dangerous for your child to participate in physical activity/ exercise?

YesNo

If yes, what are the medical condition(s)

Please type name of the person signing this document

Due to the limited numbers for the holiday program, any cancellations, 5 days prior to the event, will be charged at the full holiday program rate of $300. Please confirm your agreement

Yes I agee

Do you consent with any group photos being taken on the day to be included in social media?

Yes I consentNo I do not give consent

Please Read below, all the potential risks of your child participating in the holiday Program held on the 14th July. Please confirm that you have understood all the conditions, potential risks aasociated wiuth this program

Yes, I have read the waiver and aware of the potential risks associated with my child participating in this prgram.No, I have read the waiver and do not agree.

S6HP I’MPossible Waiver

I, certify and acknowledge; That I understand the potential risks involved in participating in any physical exercises or activities within the S6HP I'MPossible Program and assume the responsibility and risks. I understand that participating in an exercise program may include, but not limited to, serious bodily injury, heart attack, paralysis, stroke or even death. I consent voluntarily to participate in the S6HP I'MPossible Program, S6HP Remote Program delivered by S6HP I'MPossible Pty Ltd.

That the Parent or Guardian give permission for their Child named above to be able to participate in the online S6HP Remote Program, and at times communicating with the Coaches and Mentors within the online classroom.

S6HP I'MPossible is not responsible for the training environment the remote Athlete may choose to train, although advice can/will be given what a safe training environment should be, ultimately it is the responsibility of the parent to control the remote training environment.

That S6HP I'MPossible and any Coach of S6HP I'MPossible have advised me prior to the commencement of participation in the I'MPossible Program that participation could result in physical injury.

That I freely and knowingly assume the risk in all Programs delivered by S6HP I'MPossible Pty Ltd, and hereby waive any right, claim or cause of action against S6HP I'MPossible Pty Ltd and release them from any liability for any injury, cost, damage or expense, loss of personal property or claim whatsoever arising, which I or anyone on my behalf might incur as a direct result or indirect result of participation in the S6HP I'MPossible Program/s.

You acknowledge and consent to photographs and electronic images being taken of you during S6HP I'MPossible Program/s. You acknowledge and agree the such photographs or electronic images are owned by S6HP I'MPossible Pty Ltd and that they may be used on Social Media Platforms such as Facebook, Instagram, LinkedIn and websites for promotional or other purposes without your further consent.

That I have read the above and understand and agree with each of the foregoing points

Adonai Equine Services Waiver

I hereby give consent for my Child to participate in sessions at Adonai Equine Services, 89 Mitchell Park Road Cattai NSW on the terms and conditions as follows:

1. Participation in activities involving horses, involve risk of injury, as activities with horses are deemed a ‘significant high risk’ activity by our community and legal system.

2. By attending and participating in the EAL sessions you knowingly and freely assume all such risks, both known and unknown and you voluntarily enter at your own risk.

3. Horses have different temperaments and natures. All horses are potentially unpredictable, especially if frightened, hurt or mistreated. Horses will be chosen to ‘match’ the experience and feelings of new clients. Horses do explore their ‘environments’ with their bodies, so clients will be introduced to the practice of boundary-setting to choose how they wish to engage with the horses.

4. You will be offered a ‘safety guideline’ by the practitioner which supports clients in being safe, aware and making safe choices in all sessions with horses.

5. The practitioner will take all care possible and follow clear safety guidelines for the benefit of client and horses.

6. You agree not to deliberately frighten, hurt or mistreat the horses and to follow safety guidelines offered by the practitioner.

7. Adonai Equine Services makes no warranty of any kind, expressed or implied, as to the nature, habits, and disposition of any horse involved in any EAL Sessions or activities.

8. All directions by the practitioner must be observed.

9. You are responsible for wearing suitable clothing, long pants and appropriate footwear, fully covered hard shoes or boots with flat heels.

10. EAL sessions can be ‘on the ground’ or mounted /riding sessions. If mounted or riding sessions are offered, client must wear a helmet that will be provided.

11. You agree to follow the directions of the practitioner and that any misconduct or refusal by you to follow any direction of the practitioner can result in session being immediately terminated and any future sessions will be cancelled. You understand that any such non-compliance may result in injury as a result of your failure to comply.

12. In the event of an accident of any kind, you must report to the practitioner immediately. An incident report will need to be completed at the appropriate time.

13. In the event of serious accident or injury where an ambulance or medical treatment is required, you are responsible for any costs that may be required.

14. Upon entering into the Property of 89 Mitchell Park Road Cattai, you acknowledge the practitioner and/or others do not accept any liability for any accident, damage, injury or illness to you, any spectators or any other person or property whatsoever.

15. Knowing the potential inherent risks, you assume sole responsibility for any injury, death or property damage you may suffer as a result of your attendance and participation in the EAL sessions.

It is possible for a supplier of recreational services to ask you to agree that the statutory guarantees under the Australian Consumer Law (which is schedule 2 to the Competition and Consumer Act 2010 (Cth)) do not apply to you. If you sign this form, you will be agreeing that your rights (or the rights of a person for whom or on whose behalf you are acquiring the services) to sue the Provider in relation to the Provider’s services or the activities that you undertake because the services or activities provided were not in accordance with the guarantees are excluded, restricted or modified as set out below.

By signing this form, you agree that the liability of the Provider in relation to the activities (as defined by the Competition and Consumer Act 2010 (Cth), the Consumer Affairs and Fair Trading Act (NT) and the Australian Consumer Law) and recreational activities (as defined by the Civil Liability Act 2002 (NSW) and the Civil Liability Act 2002 (WA)) for any:

(a) Deaths;

(b) Physical or mental injuries (including the aggravation, acceleration or recurrence of such an injury);

(c) The contraction, aggravation or acceleration of a disease;

(d) The coming into existence, the aggravation, acceleration or recurrence of any other condition, circumstance, occurrence, activity, form of behaviour, course of conduct or state of affairs in relation to an individual:

(i) That is or may be harmful or disadvantageous to you or the community; or

(ii) That may result in harm or disadvantage to you or community;

That may be suffered by you (or a person for whom or on whose behalf you are acquiring the services) resulting from the supply of the services or activities is excluded.

You acknowledge and agree that the above provision operates to exclude the liability of the Provider as a result of a breach of an express or implied warranty that the services will be rendered with reasonable care and skill in accordance with section 5J of the Civil Liability Act 2002 (WA) and section 5N of the Civil Liability Act 2002 (NSW).

Barking with Barking

The above Waivers from Adonai Equine Services and S6HP I'mpossible, and the risks associated with the program, also applies to the handling of dogs, under the business of Barking with Bianca.

Please confirm you have read, understood and agree to the Waiver. You signature below confirms you understand the potential risks of this holiday program.