Enrolment type

I would like to enrol in:

Participant's Name

First Name

Last Name

Participant's Pronouns

Please select the preferred pronoun for the participant

Other pronoun combination

Participant's Date of Birth

Participant's email address

Participant's Mobile Phone Number

If you are attending school, please let us know which school

Participant's Address

Suburb

Post Code

PARENT/GUARDIAN (if participant is under 18 years old)

Parent/Guardian Name

(Legal guardian of the Participant)

First Name

Last Name

Relationship to Participant

Parent/GuardianEmail

This email will be the email address DRILL will use to contact you.

Parent/Guardian Phone

AGREEMENT

Both the Participant and the Parent/Guardian (if applicable) hereby agrees:

1. to participate in classes, rehearsals, workshops and performances, and follow the directions of and supervision by the DRILL Performance Company Inc. and its staff ("the Company"). 2. DRILL’s classes, rehearsals and performances will involve your child in some dancing where physical contact is required. Contact based activities and skills training are allowed to recommence in Level C of the AIS Framework for Rebooting Sport restrictions, which are currently in place in Tasmania. 3. to release the Company and the Professional Staff from any legal responsibility for loss of personal effects including money belonging to the Participant. (DRILL does not have insurance for your own gear or money) 4. to accept the inherent dangers in participation in the activities involved in the project and to accept that these risks may result in personal injury. (Dancing may potentially cause injury) 5. to release the Company and the Professional Staff from any legal responsibility for personal accidents, which are not attributable to the negligence of the Company and/or its Professional Staff. 6. (a) in the case of the participant’s accident or illness, to the Company and/or its Professional Staff seeking such medical or dental advice on behalf of the Participant as the Company and/or Professional Staff sees fit, and if in the opinion of an attending medical or dental practitioner or medical officer, the participant requires medical or dental attention or treatment including the administration of anaesthetics, blood transfusions or the performance of any surgical operation, to such being carried out if it is not possible to contact the nominated guardian within such time is considered by the medical practitioner or officer to be a reasonable period in the circumstance of the illness or accident. (b) to be responsible for and indemnify the Company in respect of all the cost of any medical and/or hospital or dental treatment referred to in 3 (a) hereof. (We will call an ambulance if we think it is required, and if we cannot get in touch with you, we will authorise emergency treatment if it is needed.) Participants and Parents/Guardians need to be aware that: (a) participants are only covered by public liability insurance while participating in the project if they are injured as a result of negligence by the Company and/or Professional Staff; (b) DRILL holds limited personal accident/sports injury insurance for participants, which may cover some costs in relation to an injury or accident. The excess will need to be covered by the parent/guardian, as well as any costs that exceed the claim limit; (c) COVID-19 has been declared a quarantinable pandemic (Quarantine Act 1908) and so is an exclusion under our insurance; (d) insurance for personal health insurance and loss or damage of personal property is the responsibility of parents/guardians and participants; (e) the Company and/or Professional Staff are not responsible for participants prior to the commencement and following the conclusion of rehearsals and/or performances each day as outlined in the schedule.

I/We have read the above conditions and hereby agree

Yes

MEDICAL/DENTAL INFORMATION

Emergency Contact (Primary)

First Name

Last Name

Relationship to the Participant

Emergency Contact 1 Mobile Number

Emergency Contact 1 second phone

Emergency Contact (Secondary)

First Name

Last Name

Relationship to the Participant

Emergency Contact 2 Phone

Participant's Medicare Number

Medicare Reference Number

The number to the left of the participant's name on the card

Medicare Expiry Date

Private Medical Insurance Provider and Number

Name of Participant's Doctor

Doctor Phone Number

Date of last tetanus vaccination

Current Medications

A list for us to give to a doctor in the case of emergency. If it is emergency medication that you need to bring to rehearsal with you, please note that here.

Previous Accidents/Illnesses/Injuries that we should be aware of

(please describe)

For Under 18s: PANADOL: I give permission for the appropriate dosage of Panadol to be given to my child if Panadol is requested by them.

Yes

Please read the following list and indicate if you have or have had any of the following conditions.

Heart Problems

Respiratory Problems/Asthma

Food Allergies

Drug Allergies

Other Allergies

Diabetes

Recent Illness/Accident/Injury

Epilepsy

Any other condition/s that we should be aware of

If you ticked any of the above, please provide more details here

I hereby authorise the Company and/or professional staff to obtain such medical or dental attention as may be deemed necessary, and I understand I am responsible for any associated costs.

Yes

PHOTOGRAPHIC/VIDEO AGREEMENT

I agree to allow DRILL to use photographic and video material which may contain my/my child's image, this year and in the future, for the purpose for the content of the work, company marketing, publicity, promotion and sharing with our funding and industry partners. Please contact DRILL if you do not wish to be photographed.

Yes

DRILL EXCLUSION POLICY

Background

Through participating in any classes or projects, DRILL aims to offer participants and Company members a safe, positive and professional dance experience. DRILL expects that young people who attend classes or are selected into the Company, understand that a high standard of cooperation, commitment and kind behaviour is expected. DRILL's programs are drug and alcohol free. Examples of poor and/or inappropriate behaviour include: • continual lateness to rehearsal or failure to attend rehearsal without explanation • demonstrated poor effort over a number of rehearsals • provocative or offensive language or conduct towards staff or other company members • damage of any kind to property • bullying or physical intimidation • not committing to the details in this contract

The DRILL EXCLUSION POLICY is a process that involves the following

• recording of any incident • follow up discussion with company member and parent (if applicable) • exclusion from the project if the behaviour is determined serious or ongoing

I understand that poor and/or inappropriate behaviour may result in me/my child being excluded from the project.

Yes

Agreed by

If you have any enquiries please contact DRILL General Manager Cathryn Gurrin on 0407 724 738 or cathryn@drillperformance.com.

Thank you. Your completed agreement form has been received.

DRILL PARTICIPANT AGREEMENT 2024