2019 Membership Form

South Cairns Gymnastics Incorporated
Affiliated with the Queensland Gymnastics Association Inc.
ABN: 59 219 090 558
Robert Road, Centenary Park
PO Box 19E Earville Qld 4870
Email: info@southcairnsgymnastics.org
Ph. 4045 2947

GymSports FNQ
ABN: 62 159 194 649
PO Box 155, Gordonvale Qld 4865
Email: info@gymsportsfnq.com.au

SCG Membership Form

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Student Details

Student First Name *

Student Middle Name *

Student Surname *

Residential Address *

Residential Address

Street number and Name

Suburb

City

State

Postcode

Country

Date of Birth *

Day/Month/Year

Gender *

Female

Male

Are you of Aboriginal or Torres Strait Island descent? *

Yes

School Attending

Year / Grade Year / Grade

Parent Details

Parent Full Name *

Parent Occupation

Postal Address - if different from Residential

Street address or PO Box

Suburb

City

State

Postcode

Country

Email Address *

Parent Phone *

MobileMobile

Work Work

HomeHome

Emergency Contact (not parent or guardian listed above) *

NameName

PhonePhone

NameName

PhonePhone

Medical History

Please provide details of any medical, physical or intellectual condition that may have a bearing on your child's ability, saftey or behaviour in class. *

Please type No if there is none

Is your child on any medication, which we should be aware of? *

Please type No if there is none

Does you child suffer from any allergies (ie.medical, bee sting etc?) *

Please type No if there is none

Does your child suffer from asthma? *

Yes

Yes, I give permission for my child to use/carry medication during classes

Gymnastics History

Has your child attended South Cairns Gymnastics before? *

Yes

If so, when?If so, when?

Has your child ever attended another gymnastics club? *

Yes

Name of club and last year at this clubName of club and last year at this club

Do you have any other children attending this gym? *

Yes

What is their name?What is their name?

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Receive your Tumble in the Tropics T-shirt:
Once we receive your completed membership form and 2019 membership fee please see front counter staff for your Tumble in the Tropics T-shirt.

Student Details

Parent Details

Medical History

Gymnastics History

Participation in gymnastics activites carries with it a reasonable assumption of risk

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