Vampires

Child's full name*
Please enter child's full name.
Please enter child's full name.

Child's Date of Birth*

Day
  • - enter the day -
  • 1
  • 2
  • 3
  • 3
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
- enter the day -
Please enter child's date of birth
Please enter child's date of birth
Month
  • - enter the month -
  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December
- enter the month -
Please enter child's date of birth
Please enter child's date of birth
Year
- enter the year -
Please enter child's date of birth
Please enter child's date of birth
Gender*
  • - select an option -
  • Female
  • Male
  • Other
- select an option -
Please enter child's gender.
Please enter child's gender.
Parent 1 full name*
Please enter parent's full name.
Please enter parent's full name.
Parent 1 mobile number*
Please enter parent's mobile phone number.
Please enter parent's mobile phone number.
Parent 2 full name
Field is required!
Field is required!
Parent 2 mobile number
Field is required!
Field is required!
Emergency contact name*
Please enter emergency contact's full name.
Please enter emergency contact's full name.
Emergency contact phone number*
Please enter emergency contact's phone number.
Please enter emergency contact's phone number.
Child's street address*
Please enter child's street address.
Please enter child's street address.
Does the child have any health conditions?*
Please answer the question.
Please answer the question.
Please list*
Please list the details.
Please list the details.
Does the child have any sporting injuries?*
Please answer the question.
Please answer the question.
Please list*
Please list the details.
Please list the details.
Does the child have any allergies?*
Please answer the question.
Please answer the question.
Please list*
Please list the details.
Please list the details.
Does child have an asthma plan?*
(Parent must supply named asthma medication to trainer for storage in team kit)
Please answer the question.
Please answer the question.
Describe treatment plan*
Please describe the details.
Please describe the details.
Child's Medicare number*
Please enter child's Medicare number.
Please enter child's Medicare number.
Does child have private health cover?*
Please answer the question.
Please answer the question.
Does child have ambulance cover?*
Please answer the question.
Please answer the question.
Do you object to blood transfusion?*
Please answer the question.
Please answer the question.

Your trainer will call an ambulance if they feel it is required regardless of the above answers and parent one will be responsible for costs incurred.

Do you permit your trainer to make medical decisions within their training capacity on behalf of your child?*
Please answer the question.
Please answer the question.
If yes type your full name and press submit*
Please type your full name.
Please type your full name.
Submit