Participant Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Phone *

(###)

###

####

Photography, Interview and Video Consent *

Physio on Chatswood and its affiliates may use photo, video or interview content involving ACE participants in present or future marketing and publications.

I hereby give my consent as the parent/guardian of the participant. I may withdraw consent at any time by contacting management at Physio on Chatswood via email.

Elements of Risk Notice and Consent *

The risk of injury exists in every athletic activity. Falls, collisions and other incidents may occur and cause injury. Due to the nature of some activities, injuries may range from minor sprains and strains to more serious injuries affecting the head (i.e., concussions), neck or back. Some injuries can lead to paralysis or prove to be life-threatening. Injuries as a result of participation in an activity can occur without fault on either the part of the student, or the company and its employees or agents, or the facility where the activity is taking place. A student choosing to participate in the activity assumes the risk of an injury occurring. The chances of an injury can be reduced by carefully following instructions at all times while engaged in the activity. Physio on Chatswood and its employees attempt to manage, as effectively as possible, the risk involved for students while participating in athletics training.

I understand the risk notice and give consent as parent/guardian of the participant.