Basketball Camp Enrolment Form

Parent's Name *

Email address *

Parent's Mobile *

Participant's Full Name *

Participant's Gender *

Female
Male

Participant's DOB (DD/MM/YYYY) *

Other Conditions (please specify)

Participant's Age *

Medical History (please select all that applies) *

ADHD/ADD
Anaphylaxis
Asthma
Autism
Diabetes
Epilepsy
Heart condition
Joint/Muscular problems
Respiratory problems
N/A
Others

Medications (please specify especially if your child needs to take medication during the session) *

Allergies (please specify) *

Please specify any behavioural traits we should be aware of that may affect involvement in the activities *

Private Health Fund *

Membership Number *

Name of Family Doctor *

Mobile of Family Doctor *

Medicare Card Expiry *

Medicare Card Number *

Emergency Contact Person *

Emergency Contact's Mobile *

Emergency Contact's Email *

Authorisation: I authorise that my child take part in the following

Photographs and videos for promotional material and social media use
Able to receive first-aid from the staff
Receive ice blocks/sweets/prizes

I confirm that I'm a person with lawful authority of the child referred to in this enrolment form and confirm that I agree to all the terms outlined below. *

Agreed and Confirmed

I am aware that Maharlika Sports staff are not medically trained, but do have first-aid training, and give consent to Maharlika staff to seek medical treatment for the child from a medical practitioner, hospital or ambulance service;
I agree to collect or make arrangements for the collection of the child referred to in this enrolment form if he/she becomes unwell or behaves poorly;
I declare that the information in this enrolment form is true and correct. I should immediately inform Maharlika Sports in the event any of this information change.
I do hereby acknowledge that of my own free will and desire, I voluntarily agree to assume the risk or any injuries, damages or loss, regardless of severity that my child may sustain as a result of being a participant in the activities connected with or associated with my child's involvement with the Summer Basketball Camp;
I confirm that I have read and agreed to the enrolment/booking terms and conditions;
I confirmed that I have disclosed all relevant medical and health information as per the above. I agree that I have made Maharlika Sports aware of all physical, mental, or health conditions which could be aggravated, worsened, or impaired by my child's participation in physical exercise or activities. I consent to medical treatment being administered to my child in an emergency.

Full Name of Parent giving consent *

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