Kids Waiver Form | Kickstarters

Your contact details

Parent/guardian name*

First Last

Parent/guardian's email address*

Mobile*

Home phone

Postal address*

Street Address Suburb Postcode

About your child

This information is necessary to ensure your child's safety, and the safety of other children in the class. No medical information will be divulged to others unless necessary for the running of the class.

Number of Children (aged 5-17 years)*

Please enter the number of children who will be attending class and for whom this waiver applies.

Child's name*

First Last

Child's date of birth*

Please select all that apply:*

Please provide details of your child's condition/s listed above

Child 2 Details

Child 2: name*

First Last

Child 2: date of birth*

Please select all that apply to child 2:*

Please provide details of child 2's condition/s listed above

Child 3 Details

Child 3: name*

First Last

Child 3: date of birth*

Please select all that apply to child 3:*

Please provide details of child 3's condition/s listed above

Child 4 Details

Child 4: name*

First Last

Child 4: date of birth*

Please select all that apply to child 4:*

Please provide details of child 4's condition/s listed above

Child 5 Details

Child 5: name*

First Last

Child 5: date of birth*

Please select all that apply to child 5:*

Please provide details of child 5's condition/s listed above

Photography

From time to time we may take photographs and video footage of the classes for promotional purposes including social media, printed materials, our website, and other online advertising.

Authorisation*

I authorise the use of images of my child/ren for the above purposes
I DO NOT authorise the use of images of my child/ren for the above purposes

Assumption of risk/waiver

I hereby enrol my child in Kickstarters self defence training on the basis of the terms and conditions set out below:

Please read and select all terms*

I acknowledge that the training, while conducted in the safest possible conditions and under qualified supervision, involves physical contact and inherent risks and I accept those risks on behalf of my child. I agree to conduct myself in a safe and mature manner and in accordance with the instructions of my instructors. I indemnify Kickstarters and Roaring Sky Sharks Pty Ltd including all instructors, staff members, and students against any loss or damage suffered by them in connection with my child’s participation in the training.
I confirm that my child is physically capable of participating in this training and that my child has no existing medical condition which precludes or should reasonably preclude their participation.
I agree to release Kickstarters and Roaring Sky Sharks Pty Ltd, including all instructors, staff members, and students from any liability whatsoever in connection with my child’s participation in this self defence training program. Without limitation, this includes all loss or damage or injury incurred as a direct or indirect result of my child’s participation.

Parent/guardian signature*

I/We agree to the above terms and conditions

Date

Phone

This field is for validation purposes and should be left unchanged.