Name* First Last Date of Birth* Date Format: DD slash MM slash YYYY Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Emergency ContactName* First Last Phone*Team Name*Consent* I hereby acknowledge that• I am aware the team price is non-refundable, even if I or my teammates are unable to play. • I understand this is a social competition and I will treat other players and staff with respect. • I understand it is my/my team’s responsibility to ensure we arrive at the correct time for our games. • I am aware that the Centre is under constant video surveillance 24/7. • I will abide by the Centre’s Code of Conduct at all times (i.e. proper behavior, appropriate clothing, enclosed shoes, carry a towel, and water bottle). • I will not use inappropriate language, aggressive behavior, threaten, bully, or intimidate other patrons or staff of the Centre. • I will not use or engage with any discriminatory behavior based on gender, religion, culture, sexual orientation, or disability. • After use sporting and related equipment must be replaced in the appropriate location.Consent* I agree to the Terms and ConditionsPrivacy Statement The Works Health & Recreation Club is wholly owned and operated by the University of Southern Queensland Student Guild (USQ Student Guild). The USQ Student Guild collects personal information to assist in providing the best fitness and related ancillary services to suit your needs and to be able to contact you regarding your membership and other associated USQ Student Guild services. Personal information will not be disclosed to third parties without your consent unless required by law. If you wish to gain access please contact The Privacy Officer, University of Southern Queensland, Toowoomba, QLD, 4350. Terms & Conditions • I acknowledge that: • If I believe there is a risk to my health by participating in a fitness activity at this fitness centre, I must inform the centre in writing about the potential risk. • I may be required to produce a Doctors Clearance Letter if any medical conditions I have could adversely be affected by exercise. I AGREE TO RELEASE AND INDEMNIFY the Recreational Activity Provider as follows: • I participate in the activity at my own risk and responsibility. • I release, indemnify and hold harmless the Recreational Activity Provider, its servants and agents, from and against all and any actions or claims which may be made by me or on my behalf or by other parties for or in respect of or in the event that I am injured or my property is damaged, I will bring no claim, legal or otherwise, against the Recreational Activity provider in respect of the injury or damage. • I have read and understood Terms and Conditions and agree to the same. • Minimum Teams required for each competition. If the minim number of teams is not signed up by the due date, the competition will be cancelled.
