The Boss Boxing TBB Registration Form

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CONFIDENTIALITY: Details on this form will be held securely and will only be shared with coaches or others who need this information in order to meet specific needs for you/your child.

First Name *

Surname *

Address *

Date of Birth *

YYYY

Gender *

Female

Male

Prefer not to say

Other:

Contact Details - mobile/email *

Medicare Card Details - name, card number, expiry date *

Private Health Fund - health care provider, membership number.

Emergency Contact 1 - name, contact number, email *

Emergency Contact 2 - name, contact number, email *

Q1). Please confirm if there are any activities that you/your child cannot participate in? *

Yes

Q2). Do you/your child have any specific medical conditions? *

Yes

Q3). Are you/your child currently taking any medication? *

Yes

Q4). Details of the medication required? (puffer/pain tablets) *

Q5). Do you/your child have any specific medical condition or disability? *

Yes

Q6). Do you/your child suffer from any allergies? (Peanuts, Wheat, Fish, Shellfish, Eggs, Soy) *

Yes

Q7). Do you/your child have any dietary requirements? (Vegan/Vegetarian, Lactose intolerance, Gluten Free) *

Yes

Q8). If you answered yes to any of the questions from 1 to 7 please give details of the medical information.

Q9). Consent information (all boxes must me ticked). *

I authorise the The Boss Boxing TBB in the event of any accident or illness, to obtain such medical and hospital assistance as required, and I agree to meet any and all expenses thereby incurred which I agree to later reimburse The Boss Boxing TBB.

I confirm that I have read, or been made aware of the organisation/clubs policies concerning - Code of Conduct for parents, coaches, children and young people.

I consent to The Boss Boxing to display, distribute or other wise use photographs, videos for their reporting and/or promotional purposes.

I can confirm that myself/child are aware of THE BOSS BOXING TBB Code of Conduct for children and anti-bullying policy.

I confirm that the information given in this form is true, complete and accurate

By ticking this I agree this is my electronic signature

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