Bonobo Holiday Camps Screening Form and Waiver
For most people, physical activity provides a basis for good health and an enhanced quality of life for the future. However, there are a small number who may be at risk when exercising, and for this reason we ask that you complete this form so that we may give you or your child the highest level of care possible. All information you give us remains confidential.
Email address *
Days registering for
Morning (9am-12.30pm)
Afternoon (12pm-3pm)
Full Day (9am-3pm)
Wed 8th Jan
Thu 9th Jan
Fri 10th Jan
Wed 15th Jan
Thu 16th Jan
Fri 17th Jan
Wed 22nd Jan
Thu 23rd Jan
Fri 24th Jan
CONTACT INFORMATION
Children(s) Name(s) *
Your answer
Child 1 Date of Birth *
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DD
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YYYY
Child 2 Date of Birth
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DD
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YYYY
Child 3 Date of Birth
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DD
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YYYY
Contact Parent/Guardian Name *
Your answer
Contact Parent/Guardian Number *
Your answer
Contact Address *
Your answer
Emergency Contact Person *
Your answer
Emergency Contact Number *
Your answer
How did you hear about us? *
Required
MEDICAL INFORMATION
Disclaimer
If your child suffers from a condition that may be triggered by exercise, we require you to provide a sign off from your doctor prior to commencing any traning
Please list any injuries or conditions that may affect this applicants physical activity with us
Your answer
Do you or your child suffer from or take any medication for a heart condition, Diabetes, Asthma or Epilepsy?
Your answer
INFORMED CONSENT
I hereby acknowledge that:
-The information provided above regarding the applicants health is, to the best of my knowledge, correct.
-I will inform you immediately if there are any changes to the information provided above.
-I give permission for my child to participate in Bonobo Ltd's fitness activities (if applicable).
I understand that participating in physical activity for this applicant carries a risk and I accept all responsibility for that risk *
Required
PHOTO CONSENT
Photos will be taken during programs for the purpose of Bonobo promotion on website and social media
I grant permission for my child(ren) to have their photo used *
Required
COMMENTS
Your answer
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