CHILD'S FULL NAME *
CHILD'S AGE, SESSION TIME, DAY AND LOCATION *
HOME ADDRESS *
EMERGENCY CONTACT NAME AND PHONE NUMBER *
EMAIL ADDRESS *
Does your child have any of the following conditions? No ConditionsDiabetesChest pains brought on by physical activityChildhood EpilepsyDizzy spells or faintingArthritis, bone or joint problemsAsthma or respiratory illnessAny sustained injuries or illnessAny allergiesTaking any medicationEver been in hospitalAnyone in the family had a heart condition from an early age
If answering yes to any of the above questions please give details below
Is there any reason why physical activity might not be suitable for your child? * YesNo
If answering YES to the above question, please state why
In signing this form, I the parent/guardian of the aforementioned child, affirm that I read this form in its entirety and that I have answered the questions accurately and to the best of my knowledge. I understand that all accidents will be documented, and that I will be informed. I understand that if the instructor requires further information about my child's illness or disability in order to include him/her in activities I will endeavour to make sure this information is available to him/her. I agree to stay with my child at all times to ensure their safety during the session. I understand that if my childs fails to behave in a manner that is polite and social, he or she may be excluded from that particular activity at the discretion of the instructor and will have the opportunity to rejoin the session shortly after. I agree to any basic first aid being administered and to my child going to hospital if necessary
Agree to terms & conditions.
I agree to photos being taken and used in social media by Triton Tots and on the website www.tritonbjj.com YesNo