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Move & Thrive Kids Enrolment
Move & Thrive Enrolment
"
*
" indicates required fields
1. What would you like to register for?
1. What would you like to register for?
*
Free Trial Class
Full Term Enrolment
2. Parent/Guardian Details
Full Name
*
First
Last
Email Address
*
Phone
*
Suburb
*
3. Child Details
How many children?
*
1
2
3
4
5
Child 1
Full Name
Child’s First Name
Child’s Last Name
Date of Birth
MM slash DD slash YYYY
Age
Gender
Male
Female
Does your child have any diagnosed disability, developmental delay or additional support needs?
No
Yes
If yes, please provide details
Medical conditions / allergies / injuries
Child 2
Full Name
Child’s First Name
Child’s Last Name
Date of Birth
MM slash DD slash YYYY
Age
Gender
Male
Female
Does your child have any diagnosed disability, developmental delay or additional support needs?
No
Yes
If yes, please provide details
Medical conditions / allergies / injuries
Child 3
Full Name
Child’s First Name
Child’s Last Name
Date of Birth
MM slash DD slash YYYY
Age
Gender
Male
Female
Does your child have any diagnosed disability, developmental delay or additional support needs?
No
Yes
If yes, please provide details
Medical conditions / allergies / injuries
Child 4
Full Name
Child’s First Name
Child’s Last Name
Date of Birth
MM slash DD slash YYYY
Age
Gender
Male
Female
Does your child have any diagnosed disability, developmental delay or additional support needs?
No
Yes
If yes, please provide details
Medical conditions / allergies / injuries
Child 5
Full Name
Child’s First Name
Child’s Last Name
Date of Birth
MM slash DD slash YYYY
Age
Gender
Male
Female
Does your child have any diagnosed disability, developmental delay or additional support needs?
No
Yes
If yes, please provide details
Medical conditions / allergies / injuries
4. Emergency Contact
Name
*
Phone Number
*
Relationship to child
*
5. Class Selection
Preferred location
*
Fridays in Tugun
Wednesdays in Nerang
6. Parent / Guardian Consent:
I understand that participation in physical activity and sport involves a level of physical risk.
I confirm that my child is physically able to participate in the activities provided.
I agree to inform Move & Thrive Kids of any medical conditions, injuries, behavioural concerns, or additional support needs that may impact my child’s participation.
I understand that while all reasonable care will be taken, Move & Thrive Kids and its staff are not responsible for injuries or accidents that may occur during participation.
I understand that children are expected to participate respectfully and safely during sessions.
In the event of an emergency, I authorise staff to seek appropriate medical assistance if required.
Digital Signature and date:
*
7. Agreements
Untitled
*
I understand this is an expression of interest and subject to approval
I understand payment is only required once approved (if applicable)
I agree to Terms & Conditions
8. Photo & Video Permission:
Does your child have any diagnosed disability, developmental delay or additional support needs?
*
YES, I give permission for photos/videos of my child to be used for promotional purposes (e.g. social media, flyers, website).
NO, I do not give permission for photos/videos of my child to be used.
9. Payment
Payment Option
*
10 Week Term Upfront Bank Transfer Payment (*Available before the term starts only)
10 Week Term Upfront Credit Card Payment (*Available before the term starts only)
Fortnightly Direct Debit
Free Trial
Upfront Fee
Price:
$ 0.00
Fortnightly Fee
Price:
$ 0.00
Fortnightly amount for 10 weeks (5 Payments)
Total
X
