Participant's Full Name
First Name
Last Name
Birthdate
dd/mm/yyyy (Please write in numerals)
Participant's Details
Gender
Male
Female
Is this your first time with us?
Yes new member
Have been before
Medical History
Does the participant have any of the following? Please select & provide further information
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Please provide details
Parent / Guardian Details
Parent / Guardian Name
First Name
Last Name
Parent / Guardian Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Participant Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Relationship
*
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Media Release
From time to time video and photos may be taken by coaches for coaching and publicity purposes. Please indicate below if you allow your child to be videoed or photographed while participating. (Images for publicity could be used on club Facebook page, website or local newspapers).
I give permission for:
*
My child’s photo/ video to be used for social media, printed publications, website and other promotional purposes for FLICK Sports Academy
I do NOT give permission for my child to be photographed and used for publicity
How did you hear about us?
Recommendation
Google Search
Social Media
Other
Please add me to your email list to receive updates on club activities and be told about holiday programs.
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Yes
No
Please Select your Program below - All programs are at Malanda Gymnastics Club, if a program is on the schedule but not on the list below then it is full. Select a Package option at the top to save 10%
*
Kindergym Holiday Package 17th Dec + 7th Jan + 14th Jan + 21st Jan,
Fit Like a Gymnast Holiday Package 17th Dec + 7th Jan + 14th Jan + 21st Jan,
WAG Levels 3/4/5 Holiday Package 17th Dec + 7th Jan + 14th Jan + 21st Jan,
Wed 7th Jan: Fit Like a Gymnast 8.30am-9.30am,
Wed 7th Jan: Kindergym 9.45am-10.45am,
Wed 7th Jan: WAG Levels 3/4/5 3.15pm-6.15pm,
Half Day Camp Package 12th Jan + 13th Jan + 15th Jan 8.30am-12.30pm,
Wed 14th Jan: Fit Like A Gymnast 8.30am-9.30am,
Wed 14th Jan: Kindergym 9.45am-1045am,
Wed 14th Jan: Gym Jam Free Time 2pm-3pm,
Wed 14th Jan: WAG Levels 3/4/5 3.15-6.15pm,
Thurs 15th Jan: Half Day Gymnastics Camp 8.30am-12.30pm,
Thurs 15th Jan: Gym Skills 8.30am-10am,
Thurs 15th Jan: Ball Games Blitz 10.15am-11.15am,
Thurs 15th Jan: Gym Jam Free Time 11.30am-12.30pm,
Half Day Camp Package 19th Jan + 20th Jan + 22nd Jan 8.30am-12.30pm,
Mon 19th Jan: Fort Building 10.15am-11.15am,
Tues 20th Jan: Half Day Gymnastics Class 8.30am-12.30pm,
Tues 20th Jan: Water Play 10.15am-11.15am,
Tues 20th Jan: Beams & Bars Bonanza 11.30am-12.30pm,
Wed 21st Jan: Fit Like a Gymnast 8.30am-9.30am,
Wed 21st Jan: Kindergym 9.45am-10.45am,
Wed 21st Jan: Gym Jam Free Time 2pm-3pm,
Wed 21st Jan: WAG Levels 3/4/5 3.15pm-6.15pm,
Thurs 22nd Jan: Half Day Gymnastics Camp 8.30am-12.30pm
Thurs 22nd Jan: Gym Skills 8.30am-10am
Thurs 22nd Jan: Ball Games Blitz 10.15am-11.15am
Thurs 22nd Jan: Gym Jam Free Time 2-3pm
Total Program Fee (Excluding Credit Card Surcharge)
Pay Via:
Credit Card (Details will be on the Xero Invoice)
Bank Transfer (details will be on the Xero invoice)
Cash (please pay in advance to hold your child's spot)
I understand that payment is due before attending the program.
*
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