Bohemian Junior Strength Clinic Sign Up Form

Junior Strength Clinic

Sign up for a 6-session strength clinic for 12-16 year olds at Bohemian Barbelle Club
Participant Information
Participant Name

First NameLast Name
Gender
Birth Date

MonthDayYear
School
Grade
Does your child compete in sport at school and if so what sport/s?
Does your child have any previous strength training experience? If so please explain

Parent/Guardian Information
Name

First NameLast Name
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Relationship to child
Alt. Phone Number
Format: (000) 000-0000.

Health and Medical Condition
Does your child have any medical conditions? If yes, please provide details.
Does your child have any injuries or physical limitations? If yes, please provide details.
Does your child take any medication regularly? If yes, please provide details.
Does your child have any allergies? If yes, please provide details.
Has your child ever been advised by a doctor not to participate in exercise or sport? If yes, please provide details.

Goal Setting
What are your child's main goals? (Select all that apply)

Other
What would you most like your child to gain from this programme?
Is there anything else we should know to help your child have the best experience possible?

Photo & Media Consent
Do you give permission for your child to appear in photos or videos used for Bohemian Barbelle Club social media and marketing?

Indemnity & Consent
Parent/Guardiam Declaration

I confirm that I am the parent or legal guardian of the participant named above and that all information provided is true and accurate to the best of my knowledge.

I understand that participation in strength training and physical activity carries an inherent risk of injury. I acknowledge that my child is participating voluntarily and declare that my child is medically fit to take part in the Junior Strength Programme.

I agree to inform the coaches promptly of any changes in my child's health or medical condition that may affect participation.

I hereby release and indemnify Bohemian Barbelle Club, including its owners, directors, coaches, employees, and representatives, from any claims, injuries, losses, or damages arising from participation in the programme, except in cases of gross negligence.
Medical Emergency Consent

I authorise the coaches, staff, or representatives of Bohemian Barbelle Club to seek, obtain, and consent to any emergency medical treatment for my child where, in their reasonable judgment, such treatment is necessary while participating in the Junior Strength Programme.

I understand that every reasonable effort will be made to contact me or an emergency contact; however, if I cannot be reached, I give permission for treatment to be administered as required. I accept responsibility for any medical expenses incurred.
I give permission for my child to participate in all activities associated with the Junior Strength Programme.

PAYMENT R900 for the Clinic

PLEASE NOTE it is your responsibility to ensure your child attends all the sessions as each one will be built on the previous one.

BANKING DETAILS:

Bohemian Barbelle Club
ABSA Bank
Cheque account
Account number 4107222464
Branch code 632005

Reference: Your FULL NAME + Junior
Email proof of payment to
amy@bohemianbarbelle.com

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature
Should be Empty:

Junior Strength Clinic

Participant Information

Parent/Guardian Information

Health and Medical Condition

Goal Setting

Photo & Media Consent

Indemnity & Consent