REGISTRATION 2018 - MT GRAVATT EAST AQUATIC CENTRE

Please complete the details below to register each swimmer. Please contact us if you have any queries.

Part A: Swimmer's Details
Full Name *
Full Name
Date of Birth
Date of Birth
Parent/Guardian
Full Name
Full Name
Health Information
Do you/your child suffer from any medical conditions? *
Do you/your child require any specific medication? *
Are you/your child allergic to anything (eg food, medication)? *
Have you/your child been immunised against Hepatitis B? *
Have you/your child been immunised against Tetanus? *
Is there any other information you would like us to be aware of? *
What is your child's swimming ability? *
Part B: Registration
Please indicate squad level *
Parent/Guardian Consent
Please complete this section if you are filling out this form as a parent/guardian.
I, the parent/guardian of the 'swimmer' (as referenced above) consent to: *
1. The child participating in any event promoted by The Swim Academy, including any tour or camp. 2. The Swim Academy staff/parent supervisors obtaining medical attention for the child at their discretion or in the event of an illness or an accident, and agree to pay any medical, pharmaceutical and ambulance/helicopter etc. transport expenses. 3. The child to be driven in a car or bus hired, chartered or driven by The Swim Academy staff or parent supervisors. 4. The Swim Academy staff/parent supervisors to give the child paracetamol or ibuprofen if he/she requires it for minor pain relief.
Consent and Waiver
I, either in my own right and/or as a person with lawful authority of the child referred to in this registration form, confirm that: *
I consent to The Swim Academy staff or supervisors taking photographs of me and/or the child for use in The Swim Academy marketing material. I am aware that The Swim Academy staff members are not medically trained, but do have first aid training, and give consent to The Swim Academy staff to seek medical treatment for me and/or the child from a medical practitioner, hospital or ambulance service. In consideration of, and as a condition of The Swim Academy permitting me and/or the child to use the Mt Gravatt East Swimming Pool and the equipment contained within it (“Facilities”) or to participate in any Tour, Camp or other activity promoted by The Swim Academy (“Activity”), I hereby acknowledge that: 1. There are significant risks associated with the use of the Facilities or participation in any Activity. 2. Those risks include, but are not limited to, personal injury arising from use and misuse of the equipment, equipment failure and the acts, omissions or negligence of other Facilities users or Activity participants. 3. At all times whilst I and/or the child are using the Facilities or participating any Activity I will assume sole responsibility for all risks associated with property and person. 4. I will not hold The Swim Academy or its owners liable for any personal injury or loss or damage to my and/or the child’s property whatsoever, including caused by the negligence of The Swim Academy owners, their employees or agents. I also undertake not to sue The Swim Academy owners or their employees or agents for any loss or damages relating to personal injury or loss or damage to property arising from the use of the Facilities or participation in any Activity.
Just a few more questions please
To assist us with our communications and marketing activities, we would appreciate if you could please help with the following questions:
How did you hear about us? *