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

Kids Club Enrolment

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

Child's Full Name

Child Date of birth

Child Gender

Parent/Guardian Full Name

Parent Phone Number

Parent Email Address

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 unwell. 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.

Waiver

This is a liability waiver and hold harmless agreement for Kid’s Club across Gold’s Gym in Western Australia. As the parent or legal guardian of the child whose name is listed in this enrolment, referred to as the 'Participant,' and in exchange for the Participant being allowed to participate in Kid’s Club activities (including use of indoor playground), the Participant and I agree to the following: Assumption of Risk - I understand that activities may involve the risk of severe bodily injury to the participant. Injuries may include minor injuries such as scratches, bruises, and sprains, major injuries such as eye injury or loss of sight, joint or back injuries, concussions, and catastrophic injuries including paralysis or death. Notwithstanding these risks and other hazards that may be foreseeable but not specifically identified herein, I, the legal guardian, the participant, and our respective heirs, personal representatives, and assigns understand, acknowledge, and expressly and voluntarily assume all risk and full responsibility for any injury arising out of or related to the activities. Release - I, the legal guardian, the participant, and our respective heirs, personal representatives, and assigns, hereby release, discharge, and agree not to sue Gold's Gym, its managers, members, employees, and/or other agents for any injury or death of the participant arising directly or indirectly from participating in the activities. This release, discharge, and covenant not to sue shall relate to any and all claims or legal rights now existing or arising in the future, including claims and legal rights arising out of any negligence of the employees, members, and/or other agents and any other breach of legal duty arising out of common law, statute, contract, or otherwise. I, as the parent or legal guardian of the participant, agree to hold Gold's Gym harmless from any claims, costs, and expenses incurred due to the participant's involvement in the activities. I certify that I have read and understood all the provisions of this document, and I acknowledge that activities may cause injury or death. I understand that this document is as broad and inclusive as permitted by law. If any provision is deemed invalid, the remaining provisions shall still be in effect.

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

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