PHOENIX CALISTHENICS CLUB 2024 REGISTRATION FORM

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Welcome to Phoenix Calisthenics Club.
The information provided is purely for club purposes and will not be shared with others.
*Please complete a registration form for each participant.

Participant's First Name *

Participant's Surname *

Participant's Date of Birth *

YYYY

Class you are registering for. Please register for the age class that the participant is turning in 2024 *

Cali-fun - Ages 3 to 5 years (Saturdays, 9am to 10am)

Sub-juniors - Ages 6 to 10 years (Saturdays, 10:30am to 12:30pm)

Juniors - Ages 11 to 13 years (Thursdays, 5:00 to 7:00pm)

Intermediates - Ages 14 to 17 years (Wednesdays, 4:30pm to 7:30pm)

Seniors - Ages 18 and above (Mondays, 6:00pm to 9:00pm)

Address (House Number and Street Name) *

Suburb *

Postcode *

Email Address (For Invoicing and Club Communications) *

2nd Email Address (Only provide if required for invoicing or club communication purposes)

1st Parent's/Guardian's Full Name *

1st Parent's/Guardian's Phone Number (or member mobile number if over 18) *

2nd Parent's/Guardian's Full Name *

2nd Parent's/Guardian's Phone Number *

Full Name of Alternative Contact (in case either parent/guardian cannot be contacted in an emergency) *

Phone Number of Alternative Contact (in case of emergency) *

Relationship of Alternative Contact to Participant *

Does your child/you (if aged over 18 yrs) suffer from any of the following medical conditions? *

ADD/ADHD

Allergies

Anaphylaxisis

Asthma

Diabetes

Eczema

Heart Condition

Seizures

None of the Above

Required

If applicable, please provide details for the above

Has your child/you (if aged over 18 yrs) ever been treated for any of the conditions below? *

Concussion

Dislocation

Fracture/Broken Bone

Head Injury

Neck Injury

Spinal/Back Injury

None of the Above

Required

If applicable, please provide details of the above

Does your child/ you (if aged over 18 yrs) suffer from any other medical condition or take regular medication? *

Yes

If answered yes, please provide details to the above question.

Does your child/you (if aged over 18 yrs) have an action plan for any medical condition? *

Yes, please email a copy to phoenixcalisecretary@gmail.com

Do you give your consent for the following? *

An ambulance to be called in an emergency (please note: in a life-threatening emergency an ambulance will be called regardless of this consent)

Administration of Paracetamol

Administration of Ventolin

Administration of Neurofen

Administration of an antihistamine

Other:

Required

If 'other' was selected, please provide details below

Please advise the name of your family doctor and medical centre *

Please advise your child's Medicare Number and Expiry Date *

Please advise if you have Private Health Insurance and if so, which provider and the policy number?

Where it is not practical to communicate with the club, I authorize for my child/myself (if aged over 18 yrs) to receive any medical treatment necessary if injury or illness occurs. I agree to pay any expenses incurred for medical treatment and transport. *

Yes

Please add anything further that you would like us to be aware of in order to clarify any of the above and/or to ensure that the best possible care is able to be given to your child/you.

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