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YoungStars
Registration
YoungStars Registration Form
IMPORTANT INFORMATION for all parents and caregivers
I (insert your name)
*
am the (please insert relationship)
*
of (insert boys name)
*
Date and Location
*
Name (Guardian)
*
First
Last
Signature (Guardian)
*
PAYMENT TERMS
Pathways Foundation Payment Terms and Refund Policy
Pathways Foundation Payment Terms and Refund Policy Please note that Pathways Foundation is a non-profit organization. We incur a lot of overheads to run our Camps and aim to keep costs for participants as low as possible. We often have waiting lists for our Camps AND it is very difficult to fill places at short notice. For this reason, we have the following payment terms and refund policy:
1.
The cost of the Young Stars Camp is $300
2.
You are required to pay the full cost of the Camp when you send in your registration form.
3.
The Camp is NON REFUNDABLE unless the Camp is cancelled by Pathways Foundation when the fees will be refunded.
4.
If you cancel your booking 6 weeks or more prior to the commencement of the Camp you may transfer to another scheduled Camp. Your paid fees will be held for a maximum of 12 months from the time of cancellation, after which the fees will no longer be transferable and will be treated as a cancellation fee by Pathways Foundation.
5.
If you cancel your booking less than 6 weeks prior to the commencement of the Camp the paid Camp fees may be NON REFUNDABLE and treated as a cancellation fee UNLESS there are extenuating circumstances leading to the cancellation when the deposit and Camp fees MAY be treated as transferable on the approval of the Operations Manager. Please provide Pathways foundation with a written request detailing the circumstances of your cancellation.
6.
Please refer www.pathwaysfoundation.org.au to ensure you have the latest registration form and terms. Prices may be subject to variation.
I have read and understood these payment terms and conditions.
*
Yes
No
REGISTRATION FORM
Name of attending boy
*
First
Last
Date of birth
*
DD
MM
YYYY
School
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
ACCOMPANYING MALE
Name of accompanying Male/Father
*
First
Last
Relationship (to attending boy)
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Note: A copy of this filled-in form will be sent to this email after completion
Do you have any medical condition that would make it difficult for you to walk up to 5kms across moderate terrain or take part in gentle morning exercises?
*
Yes
No
Please give details of any medical condition we may need to be aware of:
Do you have any medical condition that we need to be aware of or are you on any medication?
*
Yes
No
Please give details of any specific medication we may need to be aware of:
Do you have any dietary needs?
*
Yes
No
Please give details of your dietary needs:
*
Emergency Contact (Name)
*
First
Last
Emergency Contact (Phone)
*
MEDICAL FORM (ATTENDING BOY)
Does the attending boy have any dietary needs?
*
Yes
No
Please give details of the attending boys dietary needs:
*
Does the attending boy suffer from:
Fits of any kind
Dizzy spells
Travel sickness
Heart condition
Sleep disorders
Disability
Diabetes
Blackouts
Recent or recurrent illness
Migraine
Epilepsy
Mental health
Any other information related to health which we may need to know?
Does the attending boy suffer from any allergies or asthma?
*
Yes
No
ALLERGY/ASTHMA FORM
What may trigger an allergic reaction?
*
Insect bites
Plant pollens
Plants
Food groups or additives
Penicillin
Foods
Animals
Detergents or cleaning agents
Drug allergies (please specify)
Other allergies (please specify)
What are the signs and symptoms of his reaction?
What may trigger an asthmatic reaction?
Example: (food, exercise, cold weather, pollen)
What are his usual symptoms?
Example: (wheezing, coughing, tightness in chest, difficulty breathing, other)
CONSENT FORM
I, being the parent/ guardian named above, of the above-mentioned attending boy declare that I understand that the activities may involve running, jumping and water, thus exposing my son to situations and physical activity not encountered in a classroom.
I acknowledge that while
Pathways
and its staff will make every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of
Pathways
and its staff.
I hereby indemnify
Pathways
and its staff against any claim for accident or injury to my child during the course of the program.
I understand that my son’s involvement in the
Pathways
Program may mean that he is remote from immediate medical help. I have provided
Pathways
with enough written information to deal appropriately with the attending boy’s medical conditions.
I further authorise
Pathways
, in the event of any injury or illness, and where it is not possible or reasonable to obtain my consent at the time, to engage a Medical Practitioner, Ambulance or hospital facilities. In this event I agree to pay all such emergency evacuation, Ambulance, Doctor, Nurse and /or hospital expenses.
Participants will, at times, be engaging in physical and emotional processes. Full disclosure of any prior or existing conditions is required.
I/we have provided all information relating to physical or mental health and well being.
I have read, understand and agree to the consent form
*
Yes
Date
*
