Name                        

South Adelaide Squash Centre

2a Midera Avenue

Edwardstown, SA, 5038

Ph: (08) 8276 8340

SouthAdelaide@bigpond.com

South Adelaide Enrolment form

South Adelaide is committed to the Safeguarding of Children and Young People. All participants will be obliged to comply with all

Safeguarding Children and Young People Policy and practice standards as outlined on our website.

Items marked * are compulsory

Participant Details

*Surname:

*Given Name/s:

*Address:

School:

*Mobile Ph.

*Suburb:

*Postcode:

*Date of Birth:

/          /

*Gender:

Parent/Guardian/Emergency Contact Details

*Full Name:

Relationship to participant:

Home Ph:

Work Ph:

*Mobile Ph:

*Full Name:

Relationship to participant:

*Home Ph:

Work Ph:

Mobile Ph:

Medical Information

Does the participant have any impairments, disabilities, physical limitations or medical conditions? If yes, please provide details.

.

Does the participant wear glasses/contact lenses?

.

Is the participant on any medication or requiring any treatment?

.

Does the participant suffer from allergies of any kind?

                                                                                                                                                                                                                       .

Photography

During any given session, photographs and/or video footage may be taken of the participant.

These items may be used either within the centre or in printed material distributed at the centre along with posts made

on Facebook. The items will be used as promotion and will NOT contain the participant’s name.

Do you give permission for us to take photographs and/or video footage?

Yes                  No

Terms and Conditions

For the safety and benefit of all who utilise the centre, South Adelaide Squash Centre requests that you take time to read

and  understand  the  following  terms  and  conditions  which  are  available  on  our  website  or  on request:

·     The South Adelaide and SAMS policies and procedures

·     Guidelines for Adults, Children or Young People (as appropriate)

Please remember that the refund policy states that refunds will only be given on a case by case system normally for medical

 or relocation (greater than 100kms) reasons and are subject to approval by management.

How did you hear about us?

Tick all that apply:

Live locally                                         Brought children here                         Flyer in mail Ad/article in local newsletter              Other:                                             

Mailing List

South Adelaide Squash Centre maintain an electronic mailing list that you may wish to join. 

We guarantee that we will not pass your e-mail address onto any third party. 

You will receive a newsletter approximately once per month as well as any breaking news.

 If you consent to your name being added to the mailing list, please provide your e-mail address/es below:

E-mail:

Declaration

I authorise the staff, and assistants of the South Adelaide Squash Centre to obtain necessary medical assistance in the

case of an accident or medical condition and agree to pay all medical and dental expenses incurred on behalf of the above

named participant.

I appreciate that while all due care is taken, neither the South Adelaide Squash Centre, it’s staff and assistants, or anyone

connected with the centre, can be held responsible for personal injury or loss of property.

The information given above is accurate to the best of my knowledge. I have read, understood, and hereby  agree  to  the

terms  and  conditions  of  membership  above  and  as  outlined  on  the  South Adelaide Facebook page .

Signature:

Date:           /          /

The South Adelaide Squash Centre acknowledges and respects the privacy of its individuals. The information that is being collected on this document is for the

purposes of processing your enrolment in a Junior Squash program, providing you with updated information, and assisting us improve our services to you.  The

personal information collected is of the parents/guardians and of the child enrolled in the program.  By completing this form, the South Adelaide Squash Centre

accepts that the parents/guardians of the child have consented to the information being collected.  The intended recipients of this information are the South Adelaide

Squash Centre and its authorised staff. You have the right to access and alter personal information concerning yourself or your child in accordance with the

Commonwealth Privacy Act(amended 2001) and the The SAMS and South Adelaide Squash Centre Privacy Policy.  As part of your enrolment with the South

Adelaide Squash Center, you may receive information from time to time regarding our programs and services. If you wish to be kept updated with all South Adelaide

and SAMS events, programs and news like our pages on facebook to stay connected. Facebook pages to follow are: South Adelaide Squash Centre, SA Master Squash

and Squash SA.