2019 CLUB ENROLMENT FORM
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Street Address *
Your answer
Suburb *
Your answer
Postcode *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Parent / Carer - Name *
Your answer
Parent / Carer - Relationship to Child *
Your answer
Parent / Carer - Phone Number *
Your answer
Are their any medial issues we should be aware of? *
Required
If YES to medical issues, please explain here.
Your answer
Do you allow Berowra Physie to use photographic images and/or film of you on our club website page for announcements or promotional purposes? *
Required
Do you allow Berowra Physie to use photographic images and/or film on our club facebook page for announcements or promotional purposes? *
Required
Do you allow Bjelke Petersen School of Physical Culture to use photographic images and/or film on their webpage for announcements or promotional purposes? *
Required
Please inform us if the Member has any medical condition or special requirements of which we should be aware. You may include details on this form or you may discuss with us confidentially. Attendance and participation in any classes and related activities (such as competitions and displays) is at your/the Member's own risk and Berowra Physical Culture Club is not responsible or liable for: *Supervision or care of non-participating children attending classes or activities or supervision of participants outside of class times; * Any injury suffered by participants, or any other person whilst attending or participating in any class or related activity; or * Any damage to or loss of property. When submitting this form, you agree not to sue, and you release Berowra Physical Culture Club, its officeholders, instructors and members from all liability and claims whatsoever which you may have against any of them arising from or relating to these matters. We confirm that Berowra Physical Culture Club holds and will maintain appropriate insurances and will take reasonable care in the conduct of any classes and related activities, however class participants as well as family and friends attending classes and related activities must follow the instructions and reasonable requests of Berowra Physical Culture Club, its officeholders and instructors and exercise reasonable care. Please indicate your acceptance ticking 'yes' on this form. Where the Member is under 18 years this form must be signed completed by a parent or guardian.
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