Squashathon Registration Form

Don’t forget to pay the registration and shirt fee HERE.

Junior's Name *

First

Last

Junior's Date of Birth *

Which Club does your junior play at? *

Parent's Name *

First

Last

Parent's Email *

Parent's Mobile *

Please provide an additional contact number in case we are unable to get hold of you. *

Family Doctor's Name *

Family Doctor's Clinic Name *

Family Doctor's Phone Number *

Does your child have any physical health issues? If yes, please specify, and include management of the condition. *

Does your child have any mental health issues? If yes, please specify, and include management of the condition. *

Does your child have any dietary requirements, allergies or food intolerances? If yes, please specify. *

Consent to medical attention and treatment. *

I authorise the supervising Squash WA representative/s to consent to medical or surgical treatment on my behalf, as may be deemed necessary for my child, if it is impractical for prior communication with me, and agree to pay all medical and/or dental expenses incurred.

Is your junior registered with Squash WA? *

Yes
No
Unsure

If not, you will be invoiced $30 for Squash WA registration which includes insurance cover.

Comments or Questions

Squash WA

The Healthiest Sport in the World

Squashathon Registration Form

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