Term 1 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
Participant's Physical Condition
Eye Sight
Special Education / Behavioral Needs

Other (please specify)
Please provide details and strategies to support the participant:
Allergies

Other (please specify)
If any allergy is selected, please describe the allergy, typical reaction, and required treatment
Does the participant carry an EpiPen?
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
Does the participant carry an Asthma Inhaler?
Does the participant take any regular or prescribed medication?
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
2 digit month, 2 digit day, 4 digit yearDate
Package Selections and Payment

Please select the camp you would like to enrol in:

Term 1 Gymnastics: Age 3 - 5 (Beg Level)

Beg Level 3:00PM - 3:50PM Sept 25th. Oct 2nd, 9th, 16th, 30th Nov 6th, 13th, 20th and 27th

1,782.00 HKD Quantity
Item subtotal:

Term 1 Gymnastics: Age 6 - 10 (Int Level)

Int Level 4:00PM - 5:30PM Sept 25th. Oct 2nd, 9th, 16th, 30th Nov 6th, 13th, 20th and 27th

1,935.00 HKD Quantity
Item subtotal:

Term 1 Gymnastics: Age 3 - 5 (Beg Level) *Individual day*

Beg Level 3:00PM - 3:50PM Sept 25th. Oct 2nd, 9th, 16th, 30th Nov 6th, 13th, 20th and 27th

200.00 HKD

	Quantity
Sept 25th
Oct 2nd
Oct 9th
Oct 16th
Oct 30th
Nov 6th
Nov 13th
Nov 20th
Nov 27th

Item subtotal:

Term 1 Gymnastics: Age 6 - 10 (Int Level) *Individual day*

Int Level 4:00PM - 5:30PM Sept 25th. Oct 2nd, 9th, 16th, 30th Nov 6th, 13th, 20th and 27th

220.00 HKD

Date/s	Quantity
Sept 25th
Oct 2nd
Oct 9th
Oct 16th
Oct 30th
Nov 6th
Nov 13th
Nov 20th
Nov 27th

Item subtotal:

Enter coupon

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Medical Information

Consent & Waivers

Package Selections and Payment

Please select the camp you would like to enrol in: