CHILD/CHILDREN’S NAMES: 1. ___________________________________________________________
HOME ADDRESS: _____________________________________________________________
HOME PHONE: (03) _______________________
AGE (OF CHILD/REN) 1. _________________________ DATE OF BIRTH:_______________________
2. _________________________ DATE OF BIRTH:_______________________
MOTHERS Name: ________________________________ FATHERSName:_________________________________
Place of work: _________________________ Place of work: _________________________
Contact number: _______________________ Contact number: _______________________
EMERGENCY CONTACT: Name: ______________________________________________________
Relationship to child: ________________________________________
PEOPLE AUTHORISED TO
COLLECT YOUR CHILD: Name: __________________________ Phone: ___________________
Name: __________________________ Phone: ___________________
HEALTH NEEDS: e.g. any allergies (incl food), asthma, medical conditions (if medicine is to be administered by staff a consent form will need to
be signed and all details supplied)
PERSONAL INFORMATION WE SHOULD KNOW: e.g. parents divorced or dual custody
HAS YOUR CHILD PLAYED ANY ORGANISED CLUB SPORT BEFORE? NO YES (PLEASE LIST SPORTS)
I GIVE MY CONSENT FOR PHOTOGRAPHS OF MY CHILD/REN TO BE USED FOR WESTMINSTER SPORTS INC PROMOTIONAL
PURPOSES ONLY: YES NO
I approve of the above information. I understand that the programme managers/coaches will exercise due care but will not be liable for any
damage, injury or loss, which my child/ren may sustain. I understand my child will be responsible for his/her own behaviour. I authorise any
medical attention urgently required. This information is covered by the Privacy Act 1993 and will be destroyed on request. I have read and
understood Parent/Caregiver Important Information overleaf and agree to comply with all information supplied.
Signed (Parent/Caregiver):_________________________________________ Date: _____________________________
To register contact Westminster Sports Inc.
Ph: (03) 3851984 / 0272348784
Complete form and email to: firstname.lastname@example.org
Drop off to Westminster Sports office: 250 Westminster St (c/- Christchurch Football Club)
Post to: P O Box 21-302 Edgeware Christchurch 8143
Parents/Caregivers Important Information
Detailed below are important facts and information that parents/caregivers need to be aware of while your child is attending this
programme. Please understand that your child/ren are in very capable hands and safety is of the utmost importance to us.
The programme is based at Mairehau High School gymnasium and grounds at 440 Hills Rd, Mairehau and will run for 4 days
starting Monday 24 January and concluding on Thursday 27 January 2011.
The programme will operate from 9.30am – 3pm daily.
This sports based programme will include a variety of sports such as basketball, afl, football, martial arts, lacrosse and korfball to
name a few and is open to children (male & female) between the ages of 11-17.
All activities are subject to safety and availability. Changes are at the discretion of Westminster Sports Inc.
Children must register for the full 4 days.
All participants are required to sign in and out each day.
Please send children to programme with a packed lunch/adequate food and appropriate clothing and footwear eg. gym shoes and
warm clothing, hat, sunscreen, drink bottle.
Bottled water and fruit may be handed out during the programme. If you have any concerns please contact the Programme
Manager or call Westminster Sports Inc on the numbers listed.
In the event of bad weather, the programmed activities will be staged indoors (Mairehau High School gymnasium) so said activities
may be adapted from what was originally planned.
Children’s lost or broken property is not the responsibility of Westminster Sports Inc.
For urgent messages concerning your child/ren please call the Programme Manager on 0272348784
Medical and Health conditions - existing medical conditions, allergies, special needs and disabilities are to be fully detailed on the
registration form. If medicine is to be administered a consent form will need to be signed and all details supplied.
Sick children are asked, out of consideration, to be kept at home. If a child falls sick at the venue the Programme Manager will
assess the situation and if deemed appropriate will contact parents/caregiver to collect the child.
If you child is going to be absent you must call Westminster Sports on 3851984 by 9am that morning to advise.
Disciplinary Procedure - bad behaviour and/or bullying will not be tolerated on this programme. If the child’s behaviour is still a
problem after warnings from the Programme Manager, he/she will be dismissed and parents will be contacted to come and collect
Complaints/ incidents must be written down on the forms supplied at the venue.
Child Safety and Protection is vital and any suspicion of any form of child abuse will be reported to Child Youth & Family.
A Policy and Procedure manual will be available at request to view.
Staff supervising your child are all trained and equipped in coaching their respective sports. The staff to child ratio is 1-10.
Spaces available are limited.
Westminster Sports Incorporated also acknowledges the support of Mairehau High School, SpringFresh and participating sports
organisations; Canterbury AFL, Canterbury Lacrosse Assoc, Christchurch Judo School, Western AFC, Korfball Canterbury.