GENKIDS & YOUTH 412

GENKIDS & YOUTH 412 REGISTRATION - 2025

* Indicates required field

Parent / Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

PHONE NUMBER *

CHILD 1 NAME *

CHILD 1 D.O.B *

CHILD 1 SCHOOL YEAR *

CHILD 2 NAME *

CHILD 2 D.O.B *

CHILD 2 SCHOOL YEAR *

CHILD 3 NAME *

CHILD 3 D.O.B *

CHILD 3 SCHOOL YEAR *

CHILD 4 NAME *

CHILD 4 D.O.B *

CHILD 4 SCHOOL YEAR *

ALLERGIES *

EMERGENCY CONTACT NAME *

EMERGENCY CONTACT PHONE NUMBER *

MEDICARE NUMBER *

DO YOU HAVE AMBULANCE COVER? *

I agree to my family's participation in this program and understand that certain elements of the program could be physically and emotionally demanding. Furthermore, I understand that certain inherent risks and dangers exist in the activities in which my family will be participating. I acknowledge that while the organisation and its leaders will make every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of the organisation, its leaders and staff. In the event of any emergency where my nominated contact people are unavailable:
1. I authorise the leaders to obtain medical advice and/or assistance which they deem necessary.
2. I further authorise qualified practitioners to administer anaesthetic if required.
3. I accept all operation, blood transfusion and/or anaesthetic risks involved in the event that such procedures are deemed necessary.
4. I accept the responsibility for payment and agree to pay medical, transport and any other related expenses.
5. I confirm that the information provided above is true and correct.
6. I agree to inform the leader of any change to these details.

I AGREE TO THE ABOVE STATEMENT & CONDITIONS: *

YES

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