Katanning Athlete Workshop Registration Form
To be completed by Parent
Athlete/Child Name
First Name
Last Name
Athlete Date of Birth
-
Month
-
Day
Year
Date
Athlete Gender
Female
Male
Would rather not disclose
Primary Contact/Gaurdian
Name
Relation to Child
Parent/Guardian Primary Email
example@example.com
What sport/s does the athlete play?
e.g. basketball, tennis, swimming etc.
What Level of Sport has your child competed at
Club Level (within Katanning and sourrounds)
Regional Representation (Competed for Katanning/Region at a Country or State Event)
State Squad/Team Representation (State run programs/squads/teams)
National Representation
Does the athlete have any medical conditions, disabilities, injuries or other factors that may impact their ability to participate safely in physical activities or require specific support during the program? If yes, please provide details below or contact us directly to discuss how we can accommodate their needs.
Yes
No
If yes, please provide all relevant information
Parent/Guardian Emergency Contact
I, the undersigned, hereby give permission for my child to participate in the Junior Athlete Development program organized by the Great Southern Academy of Sport (GSAS).
I acknowledge that my child will be involved in physical activities, including exercises designed to enhance performance. I have provided all appropriate health and wellness information for my child.
I understand that while GSAS will take reasonable measures to ensure my child’s safety, I release the organization, its staff, and volunteers from any liability arising from participation in this program, except in cases of proven negligence.
In the event of an injury or medical emergency, I authorize GSAS staff to administer first aid and, if necessary, seek medical assistance for my child. I understand that I will be notified as soon as possible in such an event.
I consent to my child’s image being used in promotional materials, including social media posts, newsletters, and the GSAS website. (You can provide an opt-out option here if required.)
I agree to be contacted by GSAS regarding program updates and future opportunities.
Date
-
Month
-
Day
Year
Date
Signature (Parent/Guardian)
Submit
Submit
Should be Empty: