Club Application Form

Participant's Name *

Date of Birth

School

School Year

Mother's Name *

Father's Name

Home Phone

Parent's Work Phone

Parent's Mobile Phone

Address *

Email *

Medicare Number

Details of private health insurance/ambulance cover (if any)

Does your daughter suffer from any allergies? *

Yes

No

Please provide details of allergies and management plan below:

Does your daughter suffer from any medical conditions? *

Yes

No

Please provide details of medical conditions and management plan below:

Does your daughter have any dietary requirement? *

Yes

No

Please provide details of dietary requirements:

Consent Form

This consent form allows your daughter to participate in the activities conducted by Lowana. It also allows Lowana to use your daughter's images, photographs, videos for Lowana's promotions and advertisements.

consent form

Please download this consent form and either:
1) e-mail it to admin@lowana.org.au OR
2) ask your daughter to bring it with her to the club.

Payment

Please pay this by direct debit by week 4 of each term into the following account:

Lowana Club Account
BSB: 032273
Account No: 295568
Remittance: Last name and year level

Please select payment option: *

1 child/term - $60

1 child/year - $220 (paid in term 1)

3 children /term - $150

3 children /year - $560 (paid in term 1)

Please list name and school years of all children included in payment:

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High School Club Application Form

Consent Form

Payment