New MembersNew Member Candidate DetailSpecific detail about the new MemberFirst NameLast NameDoBGender Male Female Intersex Transgender Unknown Prefer Not to SayMedical / Additional Information.Please indicate any medical conditions experienced by your child.Medical Conditions Allergies Asthma Diabetes Epilepsy Heart Condition OtherAdditional Medical InformationAdd Additional Member? Yes NoNew Member 2 DetailSpecific detail about the new MemberFirst NameLast NameDoBGender Male Female Intersex Transgender Unknown Prefer Not to SayMedical / Additional Information.Please indicate any medical conditions experienced by your child.Medical Conditions Allergies Asthma Diabetes Epilepsy Heart Condition OtherAdditional Medical InformationAdd Additional Member? Yes NoNew Member 3 DetailSpecific detail about the new MemberFirst NameLast NameDoBGender Male Female Intersex Transgender Unknown Prefer Not to SayMedical / Additional Information.Please indicate any medical conditions experienced by your child.Medical Conditions Allergies Asthma Diabetes Epilepsy Heart Condition OtherAdditional Medical InformationAdd Additional Member? Yes NoIf you wish to add further new members, please contact the Rainbow Club on 1300 75 10 20 select Option 3 for Support.EmailAddressAddressCityStateZip CodeParent / GuardianFirst NameLast NamePhone/MobileParent / GuardianFirst NameLast NamePhone/MobileOther / Emergency Contact Phone No.sRISK WARNING AND EXCLUSION OF LEGAL LIABILITY This form must be signed by the member or their legal representative prior to services commencing or continuing. This form is designed for members who wish to undertake activities that may cause risk to them. Our Duty of Care is to inform each member of the risks to them if undertaking the activities, if the member wishes to partake in this activity, it is at the member’s risk.Submit Form
