Gymnastics NAIS Registration Form

Participant's Full Name*

Name on Travel Document
Preferred Name*
Date of Birth*

DayMonthYear
Gender*
Preferred Pronouns*
Address*

Street Address Line 2

State / Province

Postal / Zip CodeCountry
Contact Number*

Country CodePhone Number
E-mail*
example@example.com
Emergency Contact*
Full Name
Emergency Contact Number*

Country CodePhone Number
Alternative Emergency Contact Number*

Country CodePhone Number
Relationship*
Medical Information
ExcellentGoodFairPoor
ExcellentGoodFairPoor
NoneADHDAutism Spectrum Disorder (ASD)Dyslexia / Learning DifficultyIntellectual DisabilitySensory Processing NeedsSpeech or Language DelayBehavioral ChallengesEmotional Regulation NeedsAnxiety / Mental Health SupportOther (please specify)
Please provide details and strategies to support the participant:
NoneMedication AllergyFood Allergy (e.g. nuts, shellfish, dairy)Environmental AllergyInsect Sting AllergyOther (please specify)
If any allergy is selected, please describe the allergy, typical reaction, and required treatment
YesNo
Any other medical condition (e.g asthma, diabetes, epilepsy, heart condition, etc.), motion sickness, sleeping conditions (e.g. sleepwalk), recent surgery, or previous injuries. Please provide details and any care instructions
YesNo
YesNo
If yes, please list the medication/s, their purpose, and dosage instructions
Consent & Waivers

Please read and confirm your agreement with each statement.
Medical Consent - I authorize program staff to provide first aid and seek emergency medical treatment for the participant if necessary. I understand efforts will be made to contact me before major decisions are made.*
Liability Waiver - I understand that activities on the program involve some inherent risk to the participants. I acknowledge this and agree not to hold the organizers, staff, or partner organizations responsible for any injury, loss, or damage, except in cases of gross negligence. This waiver shall be governed by and construed in accordance with the laws of the country in which the organisation is legally registered, and any disputes shall be resolved exclusively in the courts of that jurisdiction.*
Photo & Media Consent - I give permission for the participant to be photographed or filmed during the program and for images to be used for documentation, educational, or promotional purposes.*
Code of Conduct Agreement - I agree that the participant will follow program rules, show respect to others, and cooperate with staff. I understand that serious misconduct may result in early dismissal at my own expense.*
I confirm that all information provided in this form is accurate and complete. I have read and understood the above consents and agreements.*
Printed Name
Signature*
Date*

MonthDayYear
Date
Package Selections and Payment

Please select the camp you would like to enrol in:

Term 2 Gymnastics (Beg Level)

Beg Level 3:00PM - 3:50PM March 13th, 20th, 27th. April 24th. May 8th, 15th, 22nd and 29th

1,584.00HKD Quantity
Item subtotal:0.00HKD

Term 2 Gymnastics (Int Level)

Int Level 4:00PM - 5:30PM March 6th, 13th, 20th, 27th. April 24th. May 8th, 15th, 22nd and 29th

1,935.00HKD Quantity
Item subtotal:0.00HKD

Enter coupon

Total

0.00HKD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Medical Information

Consent & Waivers

Package Selections and Payment