Registration Form

This form is to be completed prior to class participation

Gymnasts Details

Gymnasts First Name

Gynmasts Last Name

Date of Birth

Day

Month

Year

Gender

Parent/Guardian Details

Parent/Guardian First Name

Parent/Guardian Last Name

Phone

Street Address

City

State

Post Code

To help us meet your child's needs, please specify below any disabilities, weaknesses, previous injuries or allergies and first aid required.

Long answer

Emergency Contact Details (Different to Parent/Guardian)

Emergency Contact First Name

Emergency Contact Last Name

Emergency Contact Phone

Relation To Gymnast

Active Kids Vouchers

Will you be using an 'Active Kids' voucher towards your registration payment?

Yes

'Active Kids' voucher number

Consent and Declarations

Emergency Consent

I Give consent to 12x12 Gymnastics Inc. to take action in an emergency (e.g. first aid, ambulance etc) if they are unable to contact the Parent/Guardian or the Emergency contact given, in relation to an injury.

View Accident, Injury and Illness Policy

Photography

I give permision for the gymnast to be photographed/videoed while participating in activitiesat 12x12 Gymnastics Ballina Inc. or at representative activities and I consent for those photos/videos to be used for publicity if required, in both print and electronic form.

View Photography Policy

Authority and Aknowledgement of Conditions

By submitting this form I confirm and agree to become an ordinary member of 12x12 Gymnastics Ballina Inc. and I agree to the above named gymnast attending 12x12 Gymnastics Ballina Inc. I confirm I have read the terms and conditions of 12x12 Gymnastics Ballina Inc.

View Terms and Conditions

Registration Fee

2025 Registration Fee