HORSHAM CALISTHENICS COLLEGE

HORSHAM CALISTHENICS COLLEGE

ENROLMENT FORMS 2019.
Participant details.
Name of Participant.*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Date of Birth*

DayMonthYear
Date
Age as of 31st Dec this year.*
Parent/guardian name if under 18yrs.

First NameLast Name
Contact Name.*
Contact Number.*
Emergency Contact Name*
Emergency Contact Number.*
Medical.
Doctor.*

Doctors phone:*
Medicare Number*
Ambulance Fund No:*
Name and number of Private health fund:
Known complaints, if any:
Eg: Asthma, Diabeties, Epilepsy. Please also indicate treatment if to occur.
Working with Children Check Information
Parent/Guardian Name *
Participant over the age of 18.
WWCC Number *

Policies and Consent.

By checking the box you are agreeing to the following statements.
YESNO
(See information booklet for competition details). I make application to become a registered member of the Horsham Calisthenics College and in doing so l agree to abide by the constitution of the College and the directions of the committee and Coaches. Your privacy is respected by us, and the information you provide on this form may be used to register the participant with CV, to enter competitions, to list names in the concert program, to compile a class list,coaches and committee members and it may be forwarded to CV competition organising committees. If you have any privacy concerns or would like to verify information that we hold about you, please contact Kylie Hermans on 040 8811 346.
ACF Privacy Collection Statement
1. I authorise the information provided on this form to be used by the Horsham Calisthenics College for the administration of the sport of calisthenics and in accordance with the objects of the Horsham Calisthenics College. This information will be held in a club database by the College and l understand that l can access my personal information through the club upon request. If the minimum information (name & D.O.B) is not provided l might not be permitted to participate in Calisthenics conducted by the college or CV.*

I Agree.
I Agree
I agree.
I agree.
I agreeI disagreeNot Applicable
I acknowledge and consent to photographs and video footage being taken of me during my performance. I acknowledge and agree that the college, CV and the ACF may use the photographs or video footage for, training (including but not confined to adjudicators, coaches, skills examiners and competition administrators) and promotional purposes without my further consent being obtained. Further l consent to the College, CV and the ACF each using my image, likeness and also my performances, at anytime to promote the sport of calisthenics, the College,CV or the ACF by any form of media. Nothing in the paragraph grants any rights of ownership to me in the choreography of a performance for the College, CV or the ACF.
YESNO
I agree
I have read and understood the ACF Privacy Collection Statement and Media Policy and acknowledge that I am prepared to comply with these conditions.

If under the age of 18 years of age, parent/guardian must sign.
Participant Signature*

Clear
Today's date.*

MonthDayYear
Date
In fullBy installments
PAYMENT DETAILS See information booklet for amounts

Horsham Calisthenics

BSB 083 680

Account 771465615
Any questions, queries or concerns please leave a message below.
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HORSHAM CALISTHENICS COLLEGE

Participant details.

Medical.

Policies and Consent.

ACF Privacy Collection Statement

I have read and understood the ACF Privacy Collection Statement and Media Policy and acknowledge that I am prepared to comply with these conditions.