Full Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

School

Stuartholme Student

Other

Please indicate your child's current level

Please indicate your child's current level

Breather

Junior Dolphin

Dolphin

Stingray

Mini Squad

Junior Squad

Development Squad

Senior Squad

Full Name *

First Name

Last Name

Does your child suffer any medical conditions? *

Yes

No

Is your child allergic to anything? *

Yes

No

Has your child been immunised against Hepatitis B and Tetanus?

Yes

No

Does your child have any special dietary requirements?

Yes

No

Is there anything else you would like our staff to be aware of?

eg sleep walking, anxiety

Yes

No

Parent Guardian Consent Form

I give consent for academy staff/parent supervisors to obtain medical attention for my athlete 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. • My athlete to be driven in car or bus by Academy staff or parent supervisors. • Academy staff/parent supervisors to give my athlete paracetamol or ibuprofen if the athlete requires it for minor pain relief. • My athlete to participate in the 2020 Swim Camp and in all related activities. • The taking of photographs by Academy Staff or Supervisors for promotional purposes. I agree that my athlete must and will comply with the rules of the program as advised by Academy staff/parent supervisors and all rules and regulations specified by the venue.

I agree