Gold's Gym Kids Club Enrolment - Gold's Gym Australia

Kids Club Enrolment

Please complete this form for each child prior to attending Gold’s Gym Kid’s Club.

Child's Full Name

Child Date of birth

Child Gender

Parent/Guardian Full Name

Parent Phone Number

Parent Email Address

Please Select Your Home Club

Residential Address

Would you like to give booking permissions for your child to your partner/spouse?

Yes No

Please know by answering yes, you will be granting permission for the nominated person to be able to drop off and pick up your child from any Gold's Gym Kid's Club facility.

Partner/Spouse Full Name

Name of 2 people who are authorized to collect and care for the child if the parent/guardian is unavailable to be contacted in the event of any accident, injury, trauma, or illness of the child.

Emergency 1: Full name

Emergency 1: Phone Number

Emergency 1: Relationship to child

Emergency 1: Address

Emergency 2: Full name

Emergency 2: Phone Number

Emergency 2: Relationship to child

Emergency 2: Address

Other relevant information

PLEASE NOTE: We will immediately retrieve the parent to return to the creche in any case of emergency or concern. We regret that we are unable to care for sick children or children with contagious illnesses.

Are there any medical or physical conditions from which your child suffers that need to be brought to the attention of the Supervisor? Does your child have any special needs? Do we need to pay attention to any need or behavior? Any management procedure to be provided to creche staff, please give details:

Is your child up to date on immunisations?

Yes No

DIETARY RESTRICTIONS/SENSITIVITIES - Does your child have any dietary restrictions/sensitivities?

If the child suffers from Anaphylaxis or Asthma, you must outline an action plan to ensure that our staff have the best chance of responding to your child in an emergency.

Does your child suffer from any allergies?

Yes No

What is your child allergic to?

Has your child been diagnosed at risk of anaphylaxis?

Yes No

Does your child have an auto injection device (EpiPen)?

Yes No

Please outline action plan to the allergies listed above

Does your child suffer from asthma?

Yes No

Please outline your asthma action plan

Kid's Club staff are not required to change nappies. If your child needs to be changed during their time in the Kid's Club, staff will come retrieve you from the gym.

Is your child toilet trained?

Yes No

What stage are they at?

Photo Permission

I hereby agree to photos of my child being taken during the program for advertising and centre purposes

What are your child's likes and dislikes?

Please feel free to list any details about your child that will assist with our program and make your child’s stay with us a happy one.

Please read below and agree to your responsibilities while your child is in our Kid's Club

Parent's Responsibilities

In order to provide safe and affordable child-minding services for all members, Gold’s Gym operates an unlicensed crèche facility which is exempt from the childcare service act 2007. The crèche is excluded from the meaning of Child Care and is not subjected to the children and community services act 2004. For crèches to be excluded from licensing requirements, parents must remain on the premises, nearby and able to attend to their children’s immediate physical needs, such as comforting, feeding or nappy changes if required/requested by staff. I understand and agree to my responsibilities

By enrolling your child, please read and agree to the following conditions:

Conditions

By enrolling my child I agree to the following conditions: 1. Child is only acted into the Crèche from 3 months of age 2. I accept that I must stay within the facility (Gold’s Gym) while my child attends. 3. I understand that at all times I am responsible for my child while he/she attends the crèche. 4. I understand I must return immediately to the Crèche to attend to my child should I be requested to do so by crèche staff. 5. I consent to medical treatment being obtained for my child in an emergency. 6. I am willing for my child to participate in all activities offered in the crèche. I agree it is my responsibility to familiarise myself with the program and to advise the centre in writing if I do not wish my child to participate in a particular activity. 7. Although every care will be taken, staff are free from all responsibility for accidents or loss of property in connection with any child’s participation. 8. The centre reserves the right to exclude child from the Crèche for misbehaviour that is deemed inappropriate. NOTE: in the event of suspension or expulsion from the Crèche, it is the parents’ responsibility to have the child collected immediately. No monies will be refunded for that session. 9. The Centre reserves the right to refuse any child or person entry to the Crèche. 10. I agree to pay all fees and/or charges in full. 11. I have read and understood the Creche Rules, (posted within the Creche’ facility) and agree to abide by these rules 12. I understand that my child is unable to attend the creche with any symptoms of being unless. Creche staff reserve the right to refuse entry to the creche if any of these symptoms are present. 13. All signage displayed in the creche must be adhered to.

Authorisation

In the event of an accident or illness suffered by my child, I understand that the staff of the Crèche will try their best and contact me the parents/guardian. When it is impractical or impossible to communicate with me the parent/guardian, I authorise the Crèche to obtain on my behalf, such medical or surgical treatment as may be deemed necessary and in the best interest of the child. I also agree to pay any expense associated with the treatment given to my child/ren.

DECLARATION

I declare that the information above is complete and accurate, and I have read, understood, and agree to the conditions outlined above. I understand and agree that all times my child shall be at my own risk and I will not hold Gold’s Gym or its staff liable for any personal injury which may result to my child or loss of property except for any liability by Gold’s Gym if it fails to render its services with due care and skill or supplies any material in connection with those services which is not reasonably fit for the purpose for which they are supplied.

Your Name

Kids Club Enrolment

Please complete this form for each child prior to attending Gold’s Gym Kid’s Club.

- Step 1 of 11

Child's Full Name *

Child Date of birth *

Child Gender *

Parent/Guardian Details

Parent/Guardian Full Name *

Please Select Your Home Club *

Residential Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent Phone Number *

Parent Email Address *

Would you like to give booking permissions for your child to your partner/spouse? *

Please know by answering yes, you will be granting permission for the nominated person to be able to drop off and pick up your child from any Gold's Gym Kid's Club facility.

Partner/Spouse Full Name

Emergency Contact

Name of 2 people who are authorized to collect and care for the child if the parent/guardian is unavailable to be contacted in the event of any accident, injury, trauma, or illness of the child.

Emergency 1: Full name *

Emergency 1: Phone Number *

Emergency 1: Relationship to child *

Emergency 1: Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency 2: Full name *

Name of 2 people who are authorized to collect and care for the child if the parent/guardian is unavailable to be contacted in the event of any accident, injury, trauma, or illness of the child

Emergency 2: Phone Number *

Emergency 2: Relationship to child *

Emergency 2: Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Other relevant information

Medical Information

Is your child up to date on immunisations? *

DIETARY RESTRICTIONS/SENSITIVITIES - Does your child have any dietary restrictions/sensitivities?

Allergies/Asthma

If the child suffers from Anaphylaxis or Asthma, you must outline an action plan to ensure that our staff have the best chance of responding to your child in an emergency.

Does your child suffer from any allergies? *

What is your child allergic to?

Has your child been diagnosed at risk of anaphylaxis?

Does your child have an auto injection device (EpiPen)?

Please outline action plan to the allergies listed above

Does your child suffer from asthma? *

Please outline your asthma action plan

Toilet Training

Kid's Club staff are not required to change nappies. If your child needs to be changed during their time in the Kid's Club, staff will come retrieve you from the gym.

Is your child toilet trained? *

What stage are they at?

Other Information

PHOTO PERMISSION - I hereby agree/disagree to photos of my child being taken during the program for advertising and centre purposes? *

Yes — I Agree
No — I Disagree

What are your child's likes and dislikes?

Please feel free to list any details about your child that will assist with our program and make your child’s stay with us a happy one.

Parent's Responsibilities

Please read below and agree to your responsibilities while your child is in our Kid's Club

I understand and agree to my responsibilities

Conditions of Entry

By enrolling your child, please read and agree to the following conditions.

CONDITIONS OF ENTRY *

I agree

Authorisation

Please read and agree to the following.

Authorisation *

I agree

Declaration

DECLARATION — I declare that the information above is complete and accurate, and I have read, understood, and agree to the conditions outlined above. I understand and agree that all times my child shall be at my own risk and I will not hold Gold’s Gym or its staff liable for any personal injury which may result to my child or loss of property except for any liability by Gold’s Gym if it fails to render its services with due care and skill or supplies any material in connection with those services which is not reasonably fit for the purpose for which they are supplied. *

I agree

By ticking the 'I agree' box below, you agree to the above declaration

Name *

Kids Club Enrolment

Kids Club Enrolment

Parent/Guardian Details

Emergency Contact

Medical Information

Allergies/Asthma

Toilet Training

Other Information

Parent's Responsibilities

Conditions of Entry

Authorisation

Declaration

Gold's Gym Australia is a certified AUSactive Business Member.