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Online Form - School Holiday Free Fitness Activity 02/10/2018

To register your child for the Shire of Gingin School Holiday FREE Fitness Activity please complete this online form.

Terms and Conditions:

As the parent or legal guardian of the child named above (my child), I give my permission for my child to participate in the Shire of Gingin presents PT with ALI G - Free Fitness Sessions activities specified above, to be conducted by PT with ALI G.

  1. I give my permission to the supervisors of the activities appointed by the Shire of Gingin and PT with ALI G to implement a code of conduct, whereby reasonable measurers are undertaken to ensure the successful conduct of the activities and safety and well-being of the activity participants.
  2. In the event of any injury or illness to my child, I authorise the supervisors to apply or arrange first aid and to arrange examination by a registered medical practitioner and, if contact with me is impracticable or impossible, to arrange whatever medical treatment the registered medical practitioner considers necessary at that time. I will pay all medical expenses incurred on behalf of my child.
  3. I have provided all information necessary for the supervisors to plan safe participation by my child in the activities, including, if relevant, details of any activities that my child should not participate in or that should be modified for my child due to medical or other reasons.
  4. I agree to release PT with ALI G from any liability to my child or myself in relation to any injury or illness that my child may suffer, and for loss or damage to property, in connection with the activities, except to the extent that the liability arises as a result of the negligence of PT with ALI G.
  5. I agree to release the Shire of Gingin from any liability to my child or myself in relation to any injury or illness that my child may suffer, and for loss or damage to property, in connection with the activities, except to the extent that liability arises as a result of the negligence of the Shire of Gingin.
  6. I acknowledge and agree that PT with ALI G collects personal information for the purposes of conducting the activities, and that PT with ALI G may provide this personal information to the Shire of Gingin for the purposes of the Shire of Gingin administering, evaluating and reporting on the Shire of Gingin presents PT with ALI G - Free Fitness Sessions program.
  7. The Shire of Gingin may undertake an evaluation of the Shire of Gingin presents PT with ALI G - Free Fitness Sessions program and may need to gather the views of those involved in the Shire of Gingin presents PT with ALI G - Free Fitness Sessions program, including participating child and their parents\guardians. Involvement in the evaluation is voluntary, all responses will be kept confidential and any reporting will be generalised so that no one individual can be identified.  Your child may also be invited to complete a short questionnaire while participating in the Shire of Gingin presents PT with ALI G - Free Fitness Sessions program.
  1. The Shire of Gingin wishes to record images of the Shire of Gingin presents PT with ALI G - Free Fitness Sessions program, including images of child participating in activities. These images may be used in the Shire of Gingin publications, posters, events, promotional broadcasts, reporting materials and websites in any form of media.
Child details: Does your child have any food allergies?
Does your Child have any medical conditions and/or take any medication which the activity supervisor need to be aware of?
Are there any activities that your child should not participate in, or that should be modified for your child due to medical or other reasons?
Parent/Guardian details: I acknowledge that I am required to collect my child at the completion of the fitness session?
Parent/Guardian details: I grant permission for the Shire of Gingin to take respectful images of my child during the fitness session and use for promotional material?
Parent/Guardian details: I grant permission for the Shire of Gingin to undertake an evaluation survey with my child after the fitness session and use for generalised reporting?
Parent/Guardian: I have read, understood and agree to the Terms and Conditions


 
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Shire of Gingin Offices

Gingin

7 Brockman Street
Gingin WA 6503

T: (08) 9575 2211

F: (08) 9575 2121

E: mail@gingin.wa.gov.au

Lancelin

255 Vins Way
Lancelin WA 6044

T: (08) 9575 5155

F: (08) 9575 2121

E: mail@gingin.wa.gov.au

Yued Country Moore River Region