Bounce Back Program Registration

Welcome to the Bounce Back Program registration form. This form is used for all upcoming tournaments. Please fill in your details, your emergency contacts, then add each child you're registering (up to 4). If you're registering more than 4 children, please submit a second form for the additional children.

Parent/guardian details
Parent/Guardian Full Name

First NameLast Name
Relationship to child(ren)

Other
Address

Street Address

Street Address Line 2

CityState

Postcode
Mobile Number
Please enter a valid phone number, beginning with 04.Format: 0000000000.
Email
example@example.com

Emergency Contact Details

If different to Parent/guardian listed above
Name

First NameLast Name
Relationship to child(ren)

Other
Address

Street Address

Street Address Line 2

CityState

Postcode
Mobile Number
Please enter a valid phone number, beginning with 04.Format: 0000000000.

Number of children being registered

This form supports up to 4 children per submission. If you're registering more than 4 children, please complete a second form for the remaining children.
How many children are you registering on this form?

Player Information
Child's Name

First NameLast Name
Date of Birth

DayMonthYear
Participants must be at least 11 years of age.
Aboriginal/Torres Strait Islander
Gender
School
School the child is currently attending
School Year
E.g. Year 7
Alternative address

Street Address

Street Address Line 2

CityState

Postcode
Medical Information & Dietary Requirements
Medical conditions
Medication
Dietary requirements
Anything else we should know
Consent
As the legal guardian of the participant listed on this form I give consent for them to participate in the Bounce back program and all associated activities.

Player Information
Child's Name

First NameLast Name
Date of Birth

DayMonthYear
Participants must be at least 11 years of age.
Aboriginal/Torres Strait Islander
Gender
School
School the child is currently attending
School Year
E.g. Year 7
Alternative address

Street Address

Street Address Line 2

CityState

Postcode
Medical Information & Dietary Requirements
Medical conditions
Medication
Dietary requirements
Anything else we should know
Consent
As the legal guardian of the participant listed on this form I give consent for them to participate in the Bounce back program and all associated activities.

Player Information
Child's Name

First NameLast Name
Date of Birth

DayMonthYear
Participants must be at least 11 years of age.
Aboriginal/Torres Strait Islander
Gender
School
School the child is currently attending
School Year
E.g. Year 7
Alternative address

Street Address

Street Address Line 2

CityState

Postcode
Medical Information & Dietary Requirements
Medical conditions
Medication
Dietary requirements
Anything else we should know
Consent
As the legal guardian of the participant listed on this form I give consent for them to participate in the Bounce back program and all associated activities.

Player Information
Child's Name

First NameLast Name
Date of Birth

DayMonthYear
Participants must be at least 11 years of age.
Aboriginal/Torres Strait Islander
Gender
School
School the child is currently attending
School Year
E.g. Year 7
Alternative address

Street Address

Street Address Line 2

CityState

Postcode
Medical Information & Dietary Requirements
Medical conditions
Medication
Dietary requirements
Anything else we should know
Consent
As the legal guardian of the participant listed on this form I give consent for them to participate in the Bounce back program and all associated activities.

Privacy Notice and Disclaimer
PRIVACY NOTICE The purpose of collecting your personal information including your health informati Tamworth LALC to:
(a) assess whether it is appropriate for you to take part in the Bounce Back Program; and
(b) provide medical assistance to you in the case of emergency.
Your information will be supplied to Tamworth LALC staff, in the case of emergency, any health professionals involved in your care. The supply of the information is voluntary. Please be aware that Tamworth LALC needs you to provide accurate details of your health conditions and contacts so that we can ensure that appropriate care is provided to you and we can contact the appropriate person in the case of emergency. Tamworth LALC reserves the right to suspend you from its Bounce Back program if any of the information which you supplied about your medical history is false. You are entitled to access the information you have provided to Tamworth LALC by writing to Tamworth LALC. Your information will be stored at Tamworth LALC's premises for 6 months. If you have a complaint about any breach of your privacy in regard to the information you have supplied to Tamworth LALC, please contact Tamworth LALC to discuss.
DISCLAIMER
ACKNOWLEDGMENTS: I acknowledge and understand:
1. The Bounce Back Program includes physical activity, and accidents can happen which may result in injury or death.
2. Participation in the program is voluntary and undertaken in the knowledge that injury or death might result from my participation.
3. Tamworth LALC may refuse, at its absolute discretion and at any time, to allow me to participate.
4. Tamworth LALC may amend, alter or change, at its absolute discretion, any part of the program.
5. Tamworth LALC can, at its absolute discretion, cease the program at any time, with or without notice to participants.
RELEASE: I agree to discharge and release Tamworth LALC, its directors, employees, agents or contractors in respect of all liability for my death or bodily injury, or any loss or damage that may be sustained or incurred by me as a result of my participation in the program. This release covers all liability for my death or bodily injury, or any loss or damage, whether sustained or incurred as a result of negligent acts or omissions (including gross negligence), breach of contract (including fundamental breach) or of any other breach at law or statute by Tamworth LALC to the extent the law permits.
INDEMNITY: I indemnify Tamworth LALC from all actions, suits, proceedings, claims, demands, losses, damages, penalties, fines, costs and expenses however arising that I may have or may have had but for the foregoing release arising from or in connection with my participation in the program. This indemnity is in respect of all liability for my death or bodily injury, or any loss or damage, whether sustained or incurred as a result of negligent acts or omissions (including gross negligence), breach of contract (including fundamental breach) or of any other breach at law or statute by Tamworth LALC.
FITNESS TO PARTICIPATE: I declare that I am medically and physically fit and free from impairment and able to participate in the program.
Parent/Guardian Name
Date

MonthDayYear
Date
Signature

Photo Consent and Release
The Tamworth Local Aboriginal Land Council (TLALC) publicise our programs and services for the purpose of reporting to our funding bodies, to increase the number of families participating in our programs and to generally raise the profile of the TLALC. Achieving these purposes involves the production and distribution of promotional material through media including:
- Print materials including newsletters, magazines, posters, brochures, booklets and displays
- Digital Media including websites, social media, email, online advertising, Film
- Newspaper articles and advertising
Quality photographs and videos depicting children, parents and carers attending our programs are integral to ensuring these promotional materials have the greatest impact. Parents and carers are not obligated to have their or their child’s images taken. However, we appreciate individuals that agree to allow the TLALC to photograph and/or film and then use these images as noted above. If you agree to be photographed or filmed, please sign the below Acknowledgement and Consent form.
I , hereby consent and agree that Tamworth Local Aboriginal Land Council have the right to take and use images of me, my children and/or my property, and to use these in any and all media worldwide including online, now or hereafter known, for the purposes of promotion of the Tamworth LALC and their programs.

I waive any rights, claims or interest I may have to control the use of my, my child/ren’s likeness in the images and agree that any uses described herein may be made without compensation or additional consideration to me. I represent that I am at least 18 years of age, and if not, this has been signed by a Parent or Guardian. I have read and understand the above statement, and am authorised to sign on behalf of my child/ward.
Child's Name:
Parent/Guardian Name:
Date:

MonthDayYear
Date
Signature
Should be Empty:

Parent/guardian details

Emergency Contact Details

Number of children being registered

Player Information

Medical Information & Dietary Requirements

Consent

Player Information

Medical Information & Dietary Requirements

Consent

Player Information

Medical Information & Dietary Requirements

Consent

Player Information

Medical Information & Dietary Requirements

Consent

Privacy Notice and Disclaimer

DISCLAIMER

Photo Consent and Release