AICES Tour Nomination Form

Player Details

Student's name

Date of birth of student  
Student's mobile number
Parent's Mobile Number
Student's email
Sport
Age Group
School

(please select which sport)
(please select which age group)
(please select your school)
   

Player Representative History

Medical Details for Trial

Medicare:
Medicare Number Expiry Date
Private Health Fund:
Name of Fund
Membership number
Medical conditions:
Do you have any medical or special needs the team manager or coach should be aware of?

If yes, please outline details in the box
on the right, including any Asthma Plan.
Parental Consent

I give my consent for him/her to participate in the activity above and agree to delegate my authority to the staff and instructors involved. Such teachers and instructors may take whatever disciplinary action they deem necessary to ensure the safety, well-being and successful conduct of the students as a group, or individually in the above mentioned activity also authorise the teachers and instructors to obtain medical assistance, which they deem necessary should an accident occur, and agree to pay all medical expenses incurred on behalf of the above-mentioned student.

I submit the attached medical information about the above-mentioned student and include details of limitations, which he/she has for the activities concerned. I further authorise qualified medical practitioners to administer anaesthetic or any other emergency treatment as they require if such an eventuality arises.

I accept that my child is to behave in an appropriate manner and have explained this obligation to him/her. I have sighted the Code of Conduct in the Administration Section of the AICES Website www.aices.com.au  and agree that if my child seriously contravenes behavioural expectations he/she may be immediately excluded from the activity at my expense with no refund available.

I have downloaded and read the information on the website and hereby consent to my child participating in this event and that my child understands the dates and commitment and will fulfil that obligation.

Digital Signature:
Parent Full Name - please type below
Date
Parent email