Relax Lacrosse Registration - Victoria University

Welcome to the registration page for the Victoria University Relax Lacrosse Program.
The details are:
Venue - Footscray Park Aquatic & Fitness Centre, Building L, Victoria University Footscray Park Campus, Ballarat Rd, Footscray VIC 3011, Australia
Time and Date: Friday 7th June 3pm-4pm, Friday 14th June 3pm-4pm, Friday 21st June 4pm-5pm
Registering
Those who register and attend the first session receive a free Relax Lacrosse headband.
If you register and attend all 4 sessions and complete the final survey, you are eligible to enter the on the day draw for a $50 Rebel Sports voucher.

What to bring?
Water, simple sports clothes and runners

If you have questions please contact participation.officer@lacrossevictoria.com.au 

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Email *
Legal first name *
Family Name *
Date of Birth *
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Gender *
Address Line 1 *
Suburb *
Postcode *
State *
Preferred Communication (Please select one) *
Add preferred contact option below *
Do you identify as an Aboriginal / Torres Straight Islander? (Please select one) *
In the past week, on how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate?                                                                  (This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job). *
On a scale of 0 – 10, where 0 = not at all confident and 10 = extremely confident, how confident are you about being able to participate in physical activity on a regular basis? *
Medical Information
Do you have any allergies or are allergic to any medication?                                                                                                                                                                                If yes please specify *
In an emergency, do you authorise the Relax Lacrosse Coordinator to arrange any necessary medical treatment for you where prior notification has not been possible and agree to cover any associated costs of treatment and/or transportation? *
INDEMNITY: Except where provided or required by law and such cannot be excluded, I agree that the Relax Lacrosse Centre and its respective directors, officers, members, servants or agents are absolved from all liability arising from injury or damage to me, however caused, whilst participating in the Relax Lacrosse program. *
IMAGE CONSENT: I provide consent for the Relax Lacrosse Centre to record my image (photograph or video footage) for promotional purposes. I understand my image may be used in mediums including: publications and promotional material, and broadcast, print and electronic media. I acknowledge that my image will be used without any personal compensation or remuneration. I agree to forgo any rights to my image including moral rights and copyright. *
Declaration
- I agree (member) to comply with Lacrosse Victoria's Constitution, By-Laws, and Policies, including but not limited to the Lacrosse Victoria Member Protection Policy.

- I understand that the personal information provided on this form will be used to administer Relax and for related purposes including providing you with information in relation to Relax, the sport of Lacrosse and promotional offers.

- I understand that if I do not provide the information requested on this form, the Relax Lacrosse Centre might not be able to process my registration and I will not be eligible to become a member or compete in the competitions/programs.

I have read, understood and agree to the above terms and I personally consent to the application. I warrant that all information provided is true and correct.
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