U9 Nipper Registration Form - 2022/2023
Submit this form to register a child for the U9 Age Group Nipper Programs. Read the Welcome to Nippers pack for information regarding the two programs offered for nippers.

Nippers may commence either:
     A)  Before Christmas (for the Surf Sports AND Summer Holiday Programs); or
     B)  After Christmas (for the Summer Holiday Program with the option to continue afterwards)
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From the descriptions above, indicate when you will commence? *
First Name of Nipper *
Surname *
Date of Birth *
If it is not between 1 October 2013 - 30 September 2014, cancel this form and submit the form for the correct Age Group.
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Gender *
Confidential Medical Details
Current medical history - please supply all relevant information
Has this child been diagnosed with any of the following? *
Required
Specify details of ailment
Treatment/Action Plans:
List all medication this child is required to take whilst at Nipper sessions.
Dietary Requirements
Provide details of any additional information that we may need to know about your child or their circumstances.
Medicare Number *
Private Health Fund Number
Ambulance Member Number
Primary Carer Details
Name of Primary Carer *
Mobile phone *
Email address *
In the event of an emergency, if we are unable to contact the primary carer,  do you give us permission to seek the relevant medical treatment according to a Medical Practitioner's advice? *
Primary Carer's current skills
Primary Carer's learning interests
Is it likely that there may also be another carer on the beach at times? *
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