Daughters and Dads Active and Empowered Bega- Registration Form
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  • Daughters and Dads Active and Empowered - Registration Form

  • This registration form is for primary-school aged girls and their fathers/father-figures to register for the Daughters and Dads Active and Empowered Weekender program being run by Southern Women's Group at Bega Valley Public School on Friday 10th July. 

    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 Bega Valley Public School
    • 8 am - 4pm
    • Some snacks provided but please bring your Lunch
    • Please note there is a Dads' podcast series to listen to prior to attending the weekend. This will be sent to you once your registration is received.

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

  • 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?*
  • Do you ever experience unexplained pains or discomfort in your chest at rest or during physical activity/exercise?*
  • Do you ever feel faint, dizzy or lose balance during physical activity/exercise?*
  • Have you had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
  • 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?*
  • Do you have any other medical condition(s) that may make it dangerous for you to participate in physical activity/exercise?*

  • 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.

  • Daughter Registration Questions

  • 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?*
  • Does your participating daughter have a close relative who has died suddenly from a heart condition before the age of 50?*
  • Does your participating daughter have, or has she previously had, uncontrolled epilepsy or seizures/convulsions?*
  • Does your participating daughter have, or has she previously had, fainting or dizzy spells when participating in physical activity/exercise?*
  • Does your participating daughter have, or has she previously had, diabetes?*
  • Has your participating daughter had an asthma attack requiring immediate medical attention at any time over the last 12 months?*
  • Does your participating daughter have, or has she previously had, anaphylactic reactions?*
  • Has your participating daughter had surgery in the last month?*
  • Does your participating daughter have any other conditions that may make it dangerous for them to participate in physical activity/exercise?*

  • 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.

  • 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.

  • 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)*

  • 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 

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