SWG Daughters and Dads Active and Empowered

This registration form is for primary-school aged girls and their fathers/father-figures to register for the Daughters and Dads Active and Empowered program being run by Southern Women's Group in term 1, 2026.

This form should be filled in by the participating father/father-figure. Father-figures can be biological fathers, stepfathers, grandfathers, carers, uncles, family friends, adult brothers etc. Please note that you can only register for yourself and 1 daughter to attend the program together.

All sessions of the program will be held at Batemans Bay on Tuesday 3rd Feburary term 1
The first week is a dads-only session for dads to attend without their daughters and will run from 4pm
The rest of the sessions run for 1 hour and are for daughters and dads to attend together, starting at 4pm Tuesdays.

Daughters & Dads Active & Empowered is a multi-award winning, evidence-based program that brings together fathers/father-figures & their primary school-aged daughters to promote physical activity, enhance sport skills, boost well-being, strengthen the father-daughter bond & advance gender equity. The program has been studied over 10 years in rigorous research trials and won over 20 national and international awards for research excellence, improving well- being, benefitting society and community engagement.

Father Registration Questions

What is your first name?*

What is your last name?*

What is your shirt size? (You will receive a program t-shirt)*

What is your email address? (This will only be used to communicate program information and will not be shared with any third parties)*

What is your mobile number? (This will only be used to communicate program information and will not be shared with any third parties)*

Father Medical Questionnaire

Please note that the following questions are drawn from the AusActive Adult Pre-Exercise Screening System

Has your medical practitioner ever told you that you have a heart condition, or have you ever suffered a stroke?*

YesNo

Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?*

YesNo

Do you ever feel faint, dizzy or lose balance during physical activity/exercise?*

YesNo

Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*

YesNo

Do you have any diagnosed muscle, bone or joint problems that you have been told could be made worse by participating in physical activity/exercise?*

YesNo

Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?*

YesNo

Based on your responses, you will need to provide a medical clearance letter to participate in the program. Please send this to the school coordinator.

Outside of the above – please list any disabilities, illnesses, injuries, allergies or conditions that program staff need to be aware of to accommodate you to safely participate in the program? (Please note the program involves a range of physical activities including running, jumping, play-wrestling and body-resistance exercises.)

Daughter Registration Questions

What is the full name of your daughter who be participating in the program with you?*

What is your daughter's shirt size? (She will be provided with a program t-shirt)*

What is your daughter's school year?*

Daughter Medical Questionnaire

Please note that the following questions are drawn from the AusActive Pre-Exercise Screening System for Young People

Does your participating daughter have, or has she previously had, a heart condition?*

YesNo

Does your participating daughter have a close relative who has died suddenly from a heart condition before the age of 50?*

YesNo

Does your participating daughter have, or has she previously had, uncontrolled epilepsy or seizures/convulsions?*

YesNo

Does your participating daughter have, or has she previously had, fainting or dizzy spells when participating in physical activity/exercise?*

YesNo

Does your participating daughter have, or has she previously had, diabetes?*

YesNo

Has your participating daughter had an asthma attack requiring immediate medical attention at any time over the last 12 months?*

YesNo

Does your participating daughter have, or has she previously had, anaphylactic reactions?*

YesNo

Has your participating daughter had surgery in the last month?*

YesNo

Does your participating daughter have any other conditions that may make it dangerous for them to participate in physical activity/exercise?*

YesNo

Based on your responses, you will need to provide a medical clearance letter for your daughter to participate in the program. Please send this to the school coordinator.

Outside of the above – please list any disabilities, illnesses, injuries, allergies or conditions that program staff need to be aware of to accommodate your daughter to safely participate in the program? (Please note the program involves a range of physical activities including running, jumping, play-wrestling and body-resistance exercises.)

Emergency Contact Information

Please provide emergency contact details for someone who can be contacted if there is an emergency impacting you and/or your daughter.

Emergency contact full name:*

Emergency contact number:*

Emergency contact relation to you:*

Consent

Talent Release Statement

I consent to photos of myself and my daughter being used for promotional purposes by the school and the University of Newcastle. (Please read and retain a copy of the Talent Release Statement above)*

YesNo

By providing your signature below, you provide consent for yourself and your daughter to participate in the specified Daughters and Dads Active and Empowered program. You confirm that all information provided is true and accurate and confirm you have read and agree to the Terms of Participation (click to download) for both you and your daughter which include:

Data Privacy Agreement
Indemnity and Release Declaration (including authorisation for Emergency Medical Treatment)
Code of Behaviour
Child Safety and Conduct Agreement
Limitation of Liability and Release

Signature

Daughters and Dads Active and Empowered - Registration Form

Father Registration Questions

Father Medical Questionnaire

Daughter Registration Questions

Daughter Medical Questionnaire

Emergency Contact Information

Consent