Membership for Participants

As a community based organisation, RSAC requires ALL participants to have completed
the membership Application Form below:

If you would like to applyas a participant please complete the form below.
You can also use this link to access the PDF version which you can download, print and compolete manually and return to us,

Membership Information Form

First Name

Last Name

Address Line 1

Address Line 2

Suburb

State

Postcode

Phone

Mobile

Email address

EMERGENCY CONTACT 

EMERGENCY CONTACT  #1

EMERGENCY CONTACT  #2

Who is the decision maker for participant?

For Other, please complete below:

PLEASE CONFIRM BELOW:

Participant’s information is only shared for the purposes for which this application is provided. (The only exception is where information must be shared to ensure participant safety.) Consent is given to share information about this participant with:

HOW ARE YOU FUNDING THE ACTIVITY?

NDIS DETAILS

How are you managed? *

RELEASE

COMPLETE BELOW IF YOU ARE AN ADULT OVER 18 YEARS OLD

ADULT (18 and over) I the undersigned, if I am unable to be consulted in case of emergency or necessity, authorise RSAC on my behalf to take such measures & arrange for such medical & hospital treatment as may be deemed advisable for my health & wellbeing.

PLEASE SELECT THIS AS YOUR CONSENT

OR FOR PARENT OR GUARDIAN

PARENT OR GUARDIAN MEMBER OF MEMBER IF UNDER 18 &/OR USUALLY SIGNS FOR MEMBER

PARENT OR GUARDIAN MEMBER OF MEMBER IF UNDER 18 &/OR USUALLY SIGNS FOR MEMBER If I am not present at RSAC activity, so as to be consulted in case of emergency or necessity, I authorise RSAC to authorise on my behalf and on my account to take such measures and arrange for such medical and hospital treatment as RSAC may deem advisable for the health and wellbeing of (insert name of member)

Membership payment is due within 4 weeks of joining and 1st January each year.
This can be claimed through NDIA or paid on invoice.

family doctors details

BEHAVOURAL SUPPORT PLAN INFORMATION

Do you have a Behavioural Support Plan or other relevant assessment it is essential that it is provided with your Membership Information Form and that new or updated plans are provided whenever available. Any changes to conditions, must be advised immediately to ensure that we are continuing to meet participant’s current need. PLEASE ATTACH BELOW.

CONDITION

HOW TO SUPPORT PARTICIPANT

DOES THIS HAVE A MANAGEMENT PLAN?

release

ADULT (18 and over) I the undersigned, if I am unable to be consulted in case of emergency or necessity, I consent here to authorise RSAC on my behalf to take such measures and arrange for such medical and hospital treatment as may be deemed advisable for my health and wellbeing.

Recreation Sports and Aquatics Club Phone: 9790 5001
Email: rsaclub@bigpond.net.au Clubrooms: 11 Greenfield Pde Bankstown Postal address: PO Box 120 Bankstown NSW 1885 website: www.disabledsportrsac.org.au