Player Name

Gender Gender Male Female Non binary

Birth Date. Please type in DD/MM/YYYY format

Contact Email

Contact Phone

Residential Address

Parent/Guardian Name

Parent/Guardian Email

Parent/Guardian Contact Number

Are you a NDIS participant? Are you a NDIS participant? Yes No

Please provide participants NDIS number

Do you have an underlying medical or injury concerns we should be aware of? If so, please list below.

Have you (Son/Daughter if being completed by a parent) been involved in a strength training program before? If so, for how long?

Why would you like to be a part of this exclusive Athletic Institute program

What do you hope to achieve during the 10 week program?

During your time with Athletic Institute (our health & fitness partners) what key area's would you like to focus more on. Eg. Strength, Fitness, Coordination.

We know how important strength is for long term physical and mental health, but do you have any concerns about strength or fitness training? We know how important strength is for long term physical and mental health, but do you have any concerns about strength or fitness training? Yes No

If you answered yes, please state what concerns you have.

Would you like to see results for pre and post the strength training program? Would you like to see results for pre and post the strength training program? Yes No

Do you agree for your photo/image/footage to be taken and/or used for promotional purposes by either Removing Barriers Inc. or Athletic Institute Do you agree for your photo/image/footage to be taken and/or used for promotional purposes by either Removing Barriers Inc. or Athletic Institute Yes No

Will a Guardian/Carer remain on site during the program? Will a Guardian/Carer remain on site during the program? Yes No

I confirm the above information is correct at the time of registration, and I understand it is my responsibility to update Removing Barriers if anything changes. I confirm the above information is correct at the time of registration, and I understand it is my responsibility to update Removing Barriers if anything changes. Yes

I acknowledge I have read and understood the Removing Barriers Behaviour Policy. You can view this policy here www.removingbarriers.com.au/behaviour-policy I acknowledge I have read and understood the Removing Barriers Behaviour Policy. You can view this policy here www.removingbarriers.com.au/behaviour-policy Yes

Removing Barriers accepts no liability for injuries sustained by participants, nor does the venue in which the session is held. Individuals participate at their own risk. As with all physical activity programs, if you are unsure if the physical requirements are suited to you and your health, please consult with your GP. I acknowledge that I have read and agree with all statements above. Removing Barriers accepts no liability for injuries sustained by participants, nor does the venue in which the session is held. Individuals participate at their own risk. As with all physical activity programs, if you are unsure if the physical requirements are suited to you and your health, please consult with your GP. I acknowledge that I have read and agree with all statements above. Yes

I confirm I wish to register for the 10 Week Athlete Program at Athletic Institute. I confirm I wish to register for the 10 Week Athlete Program at Athletic Institute. Yes