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Insurance Form - La Trobe Sport Clubs

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Details

Date TBA

Any Time Any Where

Yes No Maybe

First name*

Last name*

Phone number*

Email address*

Address*

Club Name*

Description of Activities*

Number of CURRENT ACTIVE members*

Number of members below 18 years old*

Please choose the following that apply to your club*

Sports involving REMOTE areas

Sport involving participants being MORE THAN 2 METRES above the ground

Sports that involve MOVING at SPEEDS greater than 20km hour

CONTACT sports

Sports involving FIRE

None of the Above

Does the registration form include a disclaimer/waiver advising the risk of potential injuries?*

Yes

Does the club engage qualified instructors and professional trainers for your activities?*

Yes

Can the club confirm if all qualified instructors and professional trainers have their own insurance?

Yes

Does the Club have your own insurance? eg with an Affiliated Peak Body or a larger outside sporting body?*

Yes

Name of outside sporting body*

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*

For admins