Rutherglen Pickleball - Sport North East

Pickleball has arrived in Rutherglen!
Come and join in the fun of this exciting, easy to learn new sport. Pickleball is a mix of tennis, badminton and table tennis and can be enjoyed by all ages and abilities.

When? Wednesday evenings at 7pm on the following dates:
7th, 14th, 28 August (please note: no session on 21/8)
4th, 11th September
Where? Henderson Pavilion, 171 High St Rutherglen
Who? All welcome – bring your friends & family!

Participant Registration - Rutherglen Pickleball

Are you the participant in the Rutherglen Pickleball program? *

No, I am a parent/guardian of the participant

Yes, I am aged 14-17 years

Yes, I am 18 years and over

What is the main location (suburb / town) where your child will participate in the program? *

What is the main location (suburb / town) where you will participate in the program? *

Participant First Name *

Participant Surname *

Email *

Parent Email *

Phone *

Parent Phone Number *

Participant Gender *

Male

Female

Other

Prefer not to say

Participant year of birth (YYYY) *

Postcode *

How would you prefer to be contacted? *

Mobile phone

Facebook

Are you the parent or carer of any children in your household? This includes children over 18 years. *

Yes

Your answer to these questions has no bearing to your participation in this program.

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.

In the past week, on how many days have you done a total of 60 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.

Prior to participating in Rutherglen Pickleball, how long had it been since you participated in an organised sport program/activity outside of school? *

Prior to participating in Rutherglen Pickleball, how long had it been since your child participated in an organised sport program/activity outside of school? *

Have you played/participated in pickleball at a club before? *

Yes

Has your child played/participated in pickleball at a club before? *

Yes

Not sure

What school do you attend? (Name, Suburb/Town) *

What school does your child attend? (Name, Suburb/Town) *

Finally, these last few questions are designed solely to compare the group of people who take part in the program to the characteristics of the general population.

Where were you born? *

Australia

Overseas

Where was your child born? *

Australia

Overseas

If born overseas, how many years in total have you lived in Australia? *

If born overseas, how many years in total has your child lived in Australia? *

Do you have a disability or physical condition, which has lasted, or is likely to last for six months or more that restricts your life in some way? *

Yes

Not sure

Prefer not to say

Does your child have a disability or physical condition, which has lasted, or is likely to last for six months or more that restricts your life in some way? *

Yes

Not sure

Prefer not to say

Terms and Conditions *

I give permission for Sport North East (SNE) and its funding partners to reproduce and display photographs in which I or my child appears, in publications (including Facebook, Twitter, e-News, website), displays or paid advertising related to SNE promotion. If I do not wish for me or my child to be in any photographs or videos, I will notify Sport North East staff on the day prior to the beginning of the session. I consent for me or my child to take part in the activity/s by Sport North East, understand all information, and agree Sport North East will not incur any responsibility or liability for accident/injury/damage to/loss of property of me or my child during the activity. I authorise Sport North East to obtain medical/ambulance assistance in the case of an emergency involving me or my child, and agree to supply my child with all necessary medication and understand that staff cannot administer medication to my child. Please note your non-identifiable data will be provided to LaTrobe University on behalf of VicHealth. I understand and accept that it is my responsibility to advise Sport North East of changes to any information supplied and I will advise SNE if I do not wish to receive further information regarding research. I understand that I may receive further communication from SNE and that I can unsubscribe at any time.

I understand and agree to the above terms and conditions

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