School Holiday Program Enrolment Form

Complete the registration form below (one per child) to book your place today. Places are limited.

Child Details

Parent/Legal Guardian 1 Details

Parent/Legal Guardian 2 Details

Emergency Contacts & people authorised to collect your child/children

Emergency Contact 1

Emergency Contact 2

Medical Information

Liability Waiver: I give permission for the staff of Kiddie Kicks Soccer to give basic first aid treatment in the event of any minor injury to my child. In the event of accident or serious illness of my child, I give permission for the staff to seek medical attention or arrange ambulance transport to hospital if considered necessary for the welfare and safety of my child. I understand that I will be required to pay for any costs associated with transport and/or treatment of my child. I agree to comply with all government requirements and regulations in relation to Kiddie Kicks Soccer, Noosa Leisure Centre and its services. I am aware that my child may be excluded from the program if he or she is displaying signs of illness particularly contagious disease. As a participant in a program run by Kiddie Kicks Soccer, my son/daughter is in good health and has my permission to participate in the soccer program. Kiddie Kicks Soccer, and its directors, employees and the facilities assume no responsibility and will not be held liable for any injuries and illness, or accidents during the class resulting in medical, dental or other expenses. I also give Kiddie Kicks Soccer permission to use my child's picture in promotion of the program in printed media and other forms of advertisement. I fully renounce all claims upon Kiddie Kicks Soccer for reimbursement for the use of this material. I, on behalf of myself, my executors, administrators, heirs, next of kin, and successors, hereby covenant to hold harmless and indemnify Kiddie Kicks Soccer and all its officers, departments, agencies, and employees from any and all claims, lessees, damages, injuries, fines, penalties, and costs (including court costs and attorney's fees), charges liabilities, or exposures, however caused, resulting from or arising out of or in any way connected to my or my family's participation in any Kiddie Kicks program/services. I also agree to be placed on the Kiddie Kicks mailing list until such time as I choose to remove myself from it. I have read, understood and agree to the terms of this Agreement.