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

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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.

1300 KIDSFIT 1300 543 734

Keeping kids healthy and active whilst having fun

1300 KIDSFIT 1300 543 734

Christmas School Holiday 'Multi-Sport' Program

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