Ready Activ Extension Program
Registration Form
Thank you for registering for Ready Activ!
NB: Registration for this programme does not guarentee a place, spots are limited.
Name
Date of Birth
NRIC/FIN
Child Email
Child Phone
Parent Name
Parent Email
Parent Phone
School Attended
How did you hear about Ready Activ?
Medical Information
All information collected will be treated as strictly confidential.
Medical History
Have you been treated for any health conditions in the last year? If yes, please describe below:
Sports Injuries
Please provide details of any injuries that have been sustained in the last 2 years. For each injury, please state the type of injury (e.g. dislocation, strain, tear, fracture etc) approximate date of injury and treatment received or ongoing (e.g. surgery, physio etc).
Pre-existing conditions
Certain medical conditions or previous injuries may influence your ability to participate in sport. Examples of these include, but are not limited to, Asthma, Diabetes, Epilepsy, Spinal Injuries, Arthritis. Do you have any conditions that you, in consultation with your doctor, consider appropriate to notify Sport Ready of prior to commencement of the program? If yes, please describe below:
Covid-19 Declaration- Have you received a Health Risk Warning in the last 14 days?
Yes
No
Covid-19 Declaration- Have you received a Health Risk Alert in the last 14 days?
Yes
No
Covid- 19 Declaration- Have you had contact with any Covid-19 case in the last 14 days?
Yes
No
Covid-19 Declaration- Do you have fever, flu like symptoms, runny nose, shortness of breath, sore throat, body ache, loss of smell?
Yes
No
Vaccination Status Are you fully vaccinated? (considered fully vaccinated 14 days after 2nd dose)
Yes
No
Medical Release
I hereby declare the above information is correct and authorise Sport Ready and it's employees to act on my behalf should I require medical attention. I hereby release Sport Ready from all/any liability for any injury I/my child incur through participation in their programs. I give permission for any photographs/videoing taken of myself to be used by Sport Ready for archival, educational and promotional purposes only. I agree to notify Sport Ready if any of the above information changes.
Register