Kids Birthday | Sydney, NSW | TRANSFORM-US Fitness for Kids Pty Ltd

Keeping kids healthy and active whilst having fun

1300 KIDSFIT 1300 543 734

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Christmas School Holiday 'Multi-Sport' Program

Free Text

Payment Options:

Method of Payment:

Credit Card Number:

Card Holder's Name:

Card Expiry Date:

CCV:

BANK: CBA BSB: 062 124 ACCOUNT: 1138 4576

Reference (Child's Name):

PARTICIPANT DETAILS

Surname:

Given Names:

DOB:

Day:

Month:

Year:

Age:

Gender:

Address:

Suburb:

State:

Postcode:

Email:

PARENT/GUARDIAN DETAILS:

Surname:

Given Names:

Address:

Suburb:

State:

Postcode:

Email:

Contact Number:

Home:

Work:

Mobile:

Emergency Contact 1

Name:

Contact Number:

Emergency Contact 2:

Name:

Contact Number:

Are there any personal/emotional issues we need to know about:

If YES, please provide details:

MEDICAL CONDITIONS:

Asthma:

Is preventative medication required:

Additional Information:

Other Medical Conditions/Allergies (if any):

Special Dietary Requirements:

INDEMNITY AND RELEASE* (Please read text at the bottom of this form)

Medicare Number (First 9 Digits):

Patient No. on Card (Last Digit):

Expiry Date:

Month:

Year:

ACCEPTANCE OF INDEMNITY & TERMS:

Name:

Date:

Photographs and footage will be shot during these Multi-Sport School Holiday Programs for the purposes of marketing.

I give permission for my child to be photographed and/or filmed in action for marketing purposes.

Program Options

Please return this form complete with payment to:

TRANSFORM-US Fitness for Kids Pty Ltd, PO Box 304 Brighton-le- Sands, NSW, 2216

*REFUNDS

I acknowledge that if I need to withdraw my child's registration from any of these Christmas School Holiday Programs up to 21 days prior to the Program commencing I will receive a full payment refund. I also acknowledge that if I have to withdraw my child's registration from any of these Christmas School Holiday Programs between 21 days and 3 days prior to the Program commencing, I will receive a 50% payment refund. I acknowledge that if I have to withdraw my child's registration less than 72 hours prior to any of these Christmas School Holiday Programs commencing, or during the Program, no payment refund is due.

*INDEMNITY AND RELEASE

I acknowledge that there are inherent dangers associated with participating in a range of different sporting, fitness and outdoor activities which may result in the child being injured. To the extent permitted by law, I agree on behalf of the child and in my own right to absolve and indemnify the Program Director & Trainers delivering these Programs from any and all liability for injury, loss or damage however caused arising out of the child's participation in the Christmas School Holiday 'Multi-Sports' Programs. I agree both on behalf of my child and in my own right to release and forever discharge the Program & Trainers from all claims that I or the child may have or may have had but for this release arising from the child's participation in the Christmas School Holiday 'Multi-Sports' Programs. I authorise the Program Director to arrange medical or hospital treatment (including and without Limitation, ambulance transportation) if I am not available to do so and I indemnify the Program Director & Trainers for all costs associated therewith. I authorise the Program & Trainers or their delegates to obtain immediate ambulance, medical, dental or hospital attention should it be required. I/we understand that I/we will be informed as soon as possible after the event. I/we understand that in the first instance, the person(s) shown as the Emergency Contacts will be contacted.

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TRANSFORM-US Fitness for Kids Pty Ltd

Eastlakes NSW 2018 1300 KIDSFIT (1300 543734)

info@transform-usfitnessforkids.com.au

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