GUB Aussie Hoops Super Session Registration and Indemnity Form This form is for participants in the Aussie Hoops Super Session during the July School Holidays. GUB Aussie Hoops Super Session Name* First Last Gender*MaleFemaleDate of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Mobile Phone* School* Parent Name* First Last Parent Phone Parent Email Emergency Contact Name* First Last Emergency Contact Relationship* Emergency Contact Phone* Medical NotesPlease provide details of any medical conditions (including learning difficulties or behavioural issues, such as ASD, ADHD, etc) that our staff should be aware of.Other NotesPlease provide any further details that may assist us to provide the best experience for your child.Indemnity*I hereby authorise the staff and volunteers of Geelong United Basketball to act for me according to their best judgement in any emergency requiring medical attention, and I agree to indemnify Geelong United Basketball and its staff and volunteers in respect of anything so done. In addition, I hereby waive and release Geelong United Basketball and its staff and volunteers from any liability for any injury or illness sustained or experienced whilst participating in any GUB program, competition or event. I understand that public liability and professional indemnity insurance is held by Geelong United Basketball, but subject to the terms of the relevant policies. I also understand and agree that Geelong United Basketball has the right to use for publicity and advertising purposes any photographs or video footage of participants taken during any program, competition or event. I agree to the terms and conditions.