Hastings Secondary College - Westport Campus: All grades. After School Fitness Program. 2.30pm to 3.30pm. Monday and/or Wednesday.

您的瀏覽器尚未啟用 JavaScript，因此無法開啟檔案。請於啟用後重新載入頁面。

9 week fitness program running from Monday 17th October to Wednesday 14th December. 2.30pm to 3.30pm

Fun, social outdoor fitness program focusing on cardiovascular fitness, strength, functional fitness and agility.

登入 Google 即可儲存進度。瞭解詳情

電子郵件 *

Participant's Full Name *

Participant's Date of Birth *

YYYY

Parent/Guardian's Full Name *

Parent/Guardian's Phone Number *

What days will your child attend? *

Both Monday and Wednesday

Only Monday

Only Wednesday

必填

Does your child have any medical conditions, for example (but not limited to) allergies/anaphylaxis, asthma or diabetes? *

Yes* Further information provided below.

If you selected 'Yes' in the previous question, please provide information about your child's medical condition/s below.

Note: A health care plan, or management plan, issued by a medical practitioner will be required prior to commencement in the program.

I declare my child physically and medically fit and able to participate in the chosen activities.
*

Yes

Yes, with adjustments and accommodations. Further information provided below.

What, if any, accommodations and/or adjustments need to be made to ensure successful participation by my child.

Further information regarding participation in this program: *

I acknowledge that participation in activity programs delivered by Alicia Maree Fitness involve certain risks and could result in possible personal injury. I accept that, despite precautions being taken by Alicia Maree Fitness, accidents and incidents causing physical injury may occur.

I agree to release, waive and discharge Alicia Maree Fitness from liability for any personal injury that they may experience (including but not limited to trauma, scrapes, bruises, cuts, sprains, fractures, broken bones, concussions or loss of life), and/or property loss/damage, arising from participation in Alicia Maree Fitness activity programs.

I agree to notify Alicia Maree Fitness, in writing (aliciamaree.fit@gmail.com), if my child is affected by an injury or illness that occurs outside of the program but may affect their participation in this program. This could include, but is not limited to, concussion or head/spinal injuries.

必填

Alicia Maree Fitness will contact parents/guardians in the event of an accident, injury or illness. Please read and acknowledge the following:
*

I agree to collect or make arrangements for the collection of my child if he/she becomes unwell during the activities program.

In the event of any accident or illness, I authorise the obtaining of medical assistance on my behalf that my child may require.

I also authorise a qualified first aid staff member of Alicia Maree Fitness to administer first aid medical assistance or treatment to my child if required.

I understand that, in an emergency, an ambulance may need to be contacted. I also undertake to pay medical fees and/or any other costs which may be incurred

必填

Should Alicia Maree Fitness be unable to contact me, I authorise her to contact my child's emergency contact/s (as listed below).

* Please provide the full names and phone numbers of two emergency contacts (other than the child's primary carer).

What are your child's arrangements for travel home at the completion of each session? *

If your child is being collected by an adult, please provide further details below, i.e. person's full name, relationship to child and contact number.

If my child is being collected by an adult at the end of each session: *

I agree to ensure that he/she is collected on time (3:30pm)

Not applicable (my child is making their own way home after each session)

必填

I give permission for my child to be photographed/filmed during participation in Alicia Maree Fitness activity programs for Alicia Maree Fitness advertising and promotional purposes.

Yes

Any other information that you would like to include regarding your child's involvement in Alicia Maree Fitness program?

Declaration
*

I declare that I am the legal parent/guardian of the child and that I have the legal authority to complete this registration form on behalf of my child, or children.

I declare that the information that I have provided is accurate at the time of completing this form. If any of this information changes, I will inform Alicia Maree Fitness in writing (aliciamaree.fit@gmail.com)

必填

將我的回應複本寄給我。

提交

清除表單

請勿利用 Google 表單送出密碼。

reCAPTCHA

隱私權條款

Google 並未認可或建立這項內容。檢舉濫用情形 - 服務條款 - 隱私權政策

表單