Registration Form

Child's Full Name:

Name Of School

Child's Age:

Child's height:*

Child's inner leg length:

Child's Date of Birth:

Parent/Carers Name:

First Name Last Name

Mobile Number

Email:*

Address

Street Address Address Line 2 City State Post Code

Relationship to Child:

Child's T-shirt Size:

Sizes 6-14

Does your child require wheelchair access?

Yes

Child's disability/impaired movement is:

My child is vision impaired

Yes

Other

Can your child pull to stand with assistance?*

Yes

Can your child weight bear with assistance?

Yes

My child has impaired hearing

Yes

Other

My child enjoys:

My child dislikes:

Child's preferred communication

My child would like help with:

Sensory needs:

I would like to be part of Frame Running Wollongong because:

MEDICAL INFORMATION; Does your child have any relevant medical history applicable to Frame Running?

Yes

Details:

SHARING OF INFORMATION CONSENT

I DO give permission for Frame Running Wollongong to share information about my child with their registered volunteers to assist in the operation of their sessions. The information that I have provided will be used for the purpose and the benefit of my child to ensure their safety and well being.

I DO NOT give permission for Frame Running Wollongong to share any information about my child.

PUBLICITY CONSENT **

I DO give permission for the child named above to be involved in promotional activities or articles that appear in the newsletter, website, social media, sponsors or third parties. This may include still and/or video photography, the printing of names under photos, or printing names in relation to achievements and activities.

I DO NOT give permission for the child named above to be involved in promotional activities or articles that appear in the newsletter, website, social media, sponsors or third parties. This may include still and/or video photography, the printing of names under photos, or printing names in relation to achievements and activities.

PHYSICAL CONSENT*

I understand that the child named above will have physical contact with trainer/volunteers and other frame runners for support, training and adjusting the frame.

Signature on behalf of Information Consent, Publicity Consent, and Physical Consent.

Are you happy to receive our newsletter?:

Yes

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