Declaration and Signatures
Sign here once form has been completed to confirm that you acknowledge and agree with all of the above information:
Participant Registration Form Adaptive rugby program Term 1
Program Schedule📍 Location: Knights Rugby Club (weekly sessions unless stated). May 6 (Wed): Program Kick-Off May 12 (Tue): Titans Gala Day @ North Devils (Time TBC). May 20: Training. May 27: Training. June 3: Training. June 10: Training. June 17: Training. June 24: Training. July 1: Training. July 8: Sponsor Afternoon + Warm-Up Game & BBQ. July 11: Game vs Bundy + Dolphins vs Sharks Event
Participant Details
Name
*
First Name
Last Name
Preferred Name:
Date Of Birth:
*
 -
Day
 -
Month
Year
Address
*
Street Address
Street Address Line 2
City
State
Post Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Training Shirt Size
Please Select
XXS
XLS
S
M
L
XL
XXL
XXXL
XXXXL
XXXXXL
Training Short Size
Please Select
XXS
XLS
S
M
L
XL
XXL
XXXL
XXXXL
XXXXXL
Parent/Guardian Details
(Complete if participant is under 18 or requires supported decision-making)
Name
First Name
Last Name
Relationship to Participant
Please Select
Parent
Guardian
Carer
Other
Contact Number
Please enter a valid phone number.
Format: 0000 000 000.
Email
example@example.com
Does the participant have any medical conditions, allergies, or accessibility needs we should be aware of?
*
Please Select
Yes
No
If yes, please add details
Will a Support Worker or Carer be attending?
*
Please Select
Yes
No
If Other, please add details:
Emergency Contact Details
Full Name
*
Relationship to Participant
*
Please Select
Parent
Guardian
Partner
Support Worker
Other
Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Alternate Phone Number
Please enter a valid phone number.
Format: 0000 000 000.
Consent & Permissions
Please read and confirm the following
*
I give permission for the participant named in this form to take part in the All Abilities Touch Program.
*
I understand that the program is inclusive, non-competitive, and designed to support participants of all abilities.
*
I consent to emergency medical treatment being provided if required, in accordance with standard duty-of-care practices.
*
I give permission for photographs, video recordings, and other media to be captured during sessions by WB Supports for promotional and documentation purposes.
I DO NOT give permission for photographs, video recordings, and other media to be captured.
*
I acknowledge that participation is voluntary and agree to follow the program’s safety and conduct guidelines.
*
I understand that any photographs, video recordings, or other media captured by individuals who are not registered participants or official program staff—such as spectators, carers, or visitors—must not be recorded, published, or distributed without prior written consent from the WB Supports administrative team. Unauthorised media capture is strictly prohibited to protect the privacy and dignity of all participants.
*
I acknowledge that participation is required to pay a registration fee of $200 this will include cost of sessions for 10 weeks ($20 per session)
Name of Person Completing this form:
*
Role:
*
Please Select
Participant
Parent/Guardian
Carer
Signature
*
Date
*
 -
Day
 -
Month
Year
Date
SAVE
SAVE
Should be Empty: