All Abilities Academy – Registration & Consent Form

1. Participant Details

Participant Name(Required)

Preferred Name(Required)

Date of Birth(Required)

Age(Required)

Gender (optional)

Other gender

2. Connect Rugby League Registration

Is the participant a current Connect Rugby League Player?(Required)

Yes

If yes, registered club(Required)

Kawana Dolphins

Noosa Pirates

Caboolture Snakes

Caloundra Sharks

Other

Other club(Required)

3. Parent / Guardian / Carer Details

Guardian Name(Required)

Relationship to Participant(Required)

Guardian Phone Number(Required)

Guardian Email Address(Required)

Emergency Contact (if different)

Emergency Contact Name

Emergency Contact Number

4. Medical, Disability & Support Information

This information helps us provide a safe and inclusive environment

Disability / Diagnoses (if applicable)

Additional Support Needs

Sensory Considerations (noise, touch, heat, grass, clothing, etc.)

Communication Preferences (verbal, visual, AAC, support person)

Mobility / Physical Considerations

Medication (if required during session)

Allergies / Medical Alerts

5. Medical, Disability & Support Information

This information helps us provide a safe and inclusive environment

please supply player details

Triggers we should be aware of(Required)

Strategies that work well(Required)

Signs of distress and preferred response(Required)

Participation & Support

Will the participant attend with a parent/carer?(Required)

Yes

Can the accompanying person speak on the participant’s behalf if required?(Required)

Yes

Photography & Media Consent

I understand that while every reasonable effort will be made to respect requests not to be included in media, photography or videography, omission cannot be guaranteed. By completing this form, I consent to the use of photographs or video taken during the All Abilities Academy for promotional and reporting purposes. Please advise whether you or your player consent to being photographed or recorded:(Required)

Yes

Payment Details (Non–Connect Rugby League Players Only)

Amount payable: $35.00

Payment method(Required)

EFT

Cash

Other

Other method(Required)

EFT Payment Reference(Required)

Risk Acknowledgement & Consent

I understand that participation in physical activity involves some risk. I confirm that participation is voluntary and that the participant is medically fit to participate, and that relevant medical information has been disclosed. I agree to follow all safety instructions provided by program staff. I declare that the information provided in this form is true and correct to the best of my knowledge. Any participant requiring specific or additional supports is asked to contact us at least 7 days prior to the event so appropriate planning can occur. Please email: connectrugbyleague@gmail.com This form must be signed by the participant (where appropriate), parent/guardian, or authorised support person.

Name(Required)

Date(Required)

Signature(Required)