The Arthritis Getaway Form

The Arthritis Getaway (TAG)

IMPORTANT: The Arthritis Getaway is only for adults aged 18 – 35 years, therefore a Proof of Age document (copy of driver’s license, passport, working with childrens card) is required to register for this event.

Upload Proof of Age*
Max. file size: 16 MB.
Proof of Concession is required if purchasing a concession ticket. Please upload a scanned copy of your proof (eg. health care card/diability pension).
Upload Proof of Concession
Max. file size: 16 MB.
GENERAL INFORMATION
Title:*
Name:*
First name: Surname:
Date of Birth: (DD/MM/YYYY)*
Gender Identity:*
If you selected 'Other', please state below:
Phone (W/H):
Mobile:*
Address:*
Street Address Suburb State Postcode
Email:*
EMERGENCY CONTACT
Please note: There will be no medical staff attending this event. In case of a medical emergency, your emergency contact person’s details will be passed on to the emergency personnel.
Emergency Contact:*
First Name: Surname:
Phone (W/H):*
Mobile:*
Relationship to participant:*
MEDICAL INFORMATION
(in case of emergency)
Type of rheumatic condition:*
Age diagnosed:*
Joint/s affected:*
Family Doctor's Name:*
Phone:*
Address:*
Street Address Suburb State Postcode
Rheumatologist's Name:*
First Name: Surname:
Phone:*
Address:*
Street Address Suburb State Postcode
DIETARY REQUIREMENTS
Please list any dietary requirements including allergies:
ALLERGIES
Do you have any allergies not related to food? Please list below and upload a copy of your action plan or any relevant medical details.
Upload Action Plan
Max. file size: 16 MB.
ACTIVITIES/SPECIAL REQUIREMENTS
Do you have any special restrictions in activities?:
SWIMMING
If I choose to swim at the beach or the pool, I will do so at my own risk and not hold Arthritis & Osteoporosis WA, its employees or volunteers responsible for any harm that may occur to myself.
Can you swim?:*
Level of swimming ability:*
What would you like to achieve during The Arthritis Getaway?:
What questions would you like addressed during the educational sessions at The Arthritis Getaway?:
PARTICIPANT'S AUTHORISATION
Consent:*
The Arthritis Getaway is a program for 18 – 35 year olds with arthritis, while everyone who attends has a chronic illness and a different level of ability, you must be able to independently care for yourself. I declare that when I attend The Arthritis Getaway that I require no assistance and can independently care for myself. I will not hold Arthritis & Osteoporosis WA (AOWA), it’s employees or volunteers (TAG Leaders) responsible for any illness or injury to myself during TAG. In the event of any injury or illness, I authorise the TAG Leader to either call an ambulance (if required) or drive me to emergency services if necessary; consent to emergency medical arrangements on my behalf, where it is impractical to communicate with me, as is deemed necessary by a qualified medical practitioner. I will accept financial responsibility for any such action taken.
I give permission for any photographs/video of myself to be used at Arthritis & Osteoporosis WA's discretion.*
Transport Consent:*
I agree to using transport arranged by AOWA for pick up and drop off activities related to TAG.
The Arthritis Getaway Guidelines
For the safe conduct of the TAG event and the enjoyment of all, you must indicate your ageement to the TAG terms & conditions, which are included in the registration pack.
T&C Consent:*
I have read, understood and agree to abide by the TAG Terms and Conditions.
Proof of Age:*
I have uploaded a proof of age document (eg. copy of driver’s license, passport, working with children’s card).

The Arthritis Getaway Form

The Arthritis Getaway (TAG)

GENERAL INFORMATION

EMERGENCY CONTACT

MEDICAL INFORMATION

DIETARY REQUIREMENTS

ALLERGIES

ACTIVITIES/SPECIAL REQUIREMENTS

SWIMMING

PARTICIPANT'S AUTHORISATION

The Arthritis Getaway Guidelines