Physio Play CONSENT and ENROLMENT form

Dear Parent/Guardian,

During the Term, children will be able to participate in Physio Play classes on a weekly basis. Children will have the opportunity to develop the fundamental movement skills required for physical and cognitive development to succeed in everyday life. They will also be encouraged to learn about their bodies including identifying body parts, how to balance and coordinate movement. Developing vital strength and control in a fun and engaging environment is what Physio Play is all about!

Below you will find the details to enrol for the Term. Upon receiving your invoice for the Term, please proceed with a direct deposit payment to the bank details provided on your invoice.

Term Period: 10 Weeks

Cost: $180 ($18.00 /class x 10)

Enrol below!

Child's Name

First Name

Last Name

Date of Birth of Child

YYYY

Parent/Guardian Name

Primary Contact person

First Name

Last Name

Mobile

Best Contact number

(###)

###

####

The following information will help our coaches

1. Were there any complications during pregnancy or with the birth of your child?

2. Has your child shown preference for the left or right hand?

3. At what age did they achieve the following milestones:

3.1 Rolling

3.2 Sitting

3.3 Crawling

3.4 Standing

3.5 Walking

4. Do they participate in regular physical activity?

5. Does your child have any health conditions, allergies or disabilities?

6. Do you speak a language other than English at home?

Comments

Permission for any images of my child to be used

I give unrestricted permission for any images of my child to be used in print and digital media. I understand my child’s name will not be used in conjunction with these images. Please select one option

Yes

Permission to enrol in Physio Play at Lindfield Montessori

I give permission for my child to participate in Physio Play for the term. I understand that my child will automatically be enrolled into Physio Play for the following term unless I advise otherwise

Agree