KineticKids
ABN 70617506895
Free Trial Registration
Name
*
First Name
Last Name
Child's Name
*
Mobile Number
How did you hear about us?
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Registration Health Screening Questionnaire
Does your child have, or has your child had
*
Heart Condition
Diabetes (Type 1 or 2)
High Blood Pressure
Breathing problems or shortness of breath (Eg Asthma)
Muscular pain during exercise
Epilepsy
None of the above
If any of the above conditions selected please detail.
Does your child have, or has your child had difficulty/problems with any of the following?
*
Vision
Hearing
Speech Language
Motor Sensory Skills
Poor Balance/instability
Sleep Apnoea
None of the above
I acknowledge that:
The information provided above regarding my childs health is, to the best of my knowledge accurate and correct.
I will inform KineticKids immediately if there are any changes to the information provided.
I give permission for my child to commence physical activity program provided by KineticKids.
TO WAIVE ANY AND ALL CLAIMS that I have or may in the future against Kinetic Kids Pty Ltd and any and all liability for any loss, damage, expense or injury, including death, that I may suffer or that my child may suffer as a result of my participation in KineticKids programs.
I give permission for photographs/video footage to be taken during classes and other KineticKids activities and I give permission for KineticKids to use these for promotional purposes including Facebook and website publication.
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