Welcome to Tanjule Rhythmic Gymnastics Club!

 Please complete pages 1 and 2 of  this form and bring to your next training with the $40 registration fee.  This is a compulsory annual fee to register and insure our gymnasts through GymnasticsSA – and is due immediately.    Thank you!

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TANJULE RHYTHMIC GYMNASTICS CLUB - PAGE 1 OF 2

Annual Registration Form 2014  -  return next training please      PLEASE PRINT CLEARLY

Gymnast’s Info

Last Name		First Name
Date of Birth		Gender
Residential Address		Postal Address
Is gymnast of Aboriginal or Torres Strait Island Descent?       Y/N

Parents’/Guardians’ Info

*Primary contact	Full Name:	Relationship:
	Phone:	(H)		(W)	(M)
	**Email:
	Newsletters will be emailed to the primary contact unless otherwise indicated
*Secondary contact	Full Name:	Relationship:
	Phone:	(H)	(W)		(M)
	**Email:

* In case of emergency

**By providing an email address, I agree to be contacted electronically.

Medical History

Provide details of any medical, physical or intellectual condition that may have a bearing on the Gymnast’s ability, safety or behaviour in class    ___________________________________________________________________________________________________

Is the Gymnast on any medication of which we should be aware? If so, describe: __________________________________________________________________________________

Does the Gymnast suffer from any allergies (ie: asthma, bee stings etc)? __________________________________________________________________________________

If so, please ensure that the Gymnast has sufficient allergy medication with him/herself and is able to self-administer this medication when necessary.

Family Doctor’s Name/Surgery:__________________________ Contact Number  ______________

Parent/Guardians Name and signature:   __________________________________date:   /    /