carlton baths

Please provide details of the skater who will be participating

PLEASE NOTE
Your place in the program will not be finalised until your registration form is completed and payment is received.

If needed, there is an option to Save and Continue your registration. Simply click the 'save and continue later' link at the bottom of the registration form and you will be provided with a secure link to return to your form at any stage.

You can register up to 3 participants online. You will receive $10 off your second registration and $10 off your third registration.
PROGRAM DETAILS
Which Program Are You Registering For?*
PARTICIPANT DETAILS
Unless stated, please complete all questions as they relate to the participant.
Participant First Name*
Participant Last Name*
Select Your Age Group*
Are you the participant in We Roll?*
Other - please specify
Gender*
Year of Birth*
Postcode*
What school do you attend?*
Email Address*
Telephone Number*
Who's Contact Details Are These?*

Save and Continue Later

ADDITIONAL PARTICIPANT REGISTRATION
Please advise below if you would like to register a second participant.
Do you need to register a second participant?*
PARTICIPANT 2 DETAILS
Unless stated, please complete all questions as they relate to PARTICIPANT 2.
Participant First Name*
Participant Last Name*
Age Group*
Gender*
Year of Birth*
Postcode*
What school do you attend?*
CONTACT DETAILS
Please let us know if you would like to provide alternate contact details for Participant 2.
Do you want to provide alternate contact details for Participant 2?*

No, please use the same contact details for Participant 1

Yes, I need to provide new contact details
Email Address*
Telephone Number*
Who's Contact Details Are These?*
PROGRAM DETAILS
Please complete all questions as they relate to PARTICIPANT 2.
Do you need to borrow skates? If yes, what size shoe are you?*
Your shoe size
YOUR FITNESS
Please complete all questions as they relate to PARTICIPANT 2.
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?*
How confident are you about being able to participate in physical activity on a regular basis?*
Prior to participating in We Roll, how long had it been since you participated in an organised sport program / activity outside of school?*
If you have participated in organised sport outside of school in the last 12 months, how often was this?
This question to be completed by the Skater only. Do you agree or disagree with the following statement relating to the way in which we view ourselves? The statement is 'I feel connected with others'.
Have you played / participated in Roller Skating / Roller Sport (at a club) before?*
Have you played / participated in Roller Skating / Roller Sport (at a rink or just for fun) before?*
GROUP DYNAMIC
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. Please complete all questions as they relate to PARTICIPANT 2.
Where were you born?*
If born overseas, how many years in total have you lived in Australia?*
Are you of Aboriginal or Torres Straight Islander origin?*
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?*

Save and Continue Later

ADDITIONAL PARTICIPANT REGISTRATION
Please advise below if you would like to register a third participant.
Do you need to register a third participant?*
PARTICIPANT 3 DETAILS
Unless stated, please complete all questions as they relate to PARTICIPANT 3.
Participant First Name*
Participant Last Name*
Age Group*
Gender*
Year of Birth*
Postcode*
What school do you attend?*
CONTACT DETAILS
Please let us know if you would like to provide alternate contact details for Participant 3.
Do you want to provide alternate contact details for Participant 3?*

No, please use the same contact details for Participant 1

No, please use the same contact details for Participant 2

Yes, I need to provide new contact details
Email Address*
Telephone Number*
Who's Contact Details Are These?*
PROGRAM DETAILS
Please complete all questions as they relate to PARTICIPANT 3.
Do you need to borrow skates? If yes, what size shoe are you?*
Your shoe size
YOUR FITNESS
Please complete all questions as they relate to PARTICIPANT 3.
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?*
How confident are you about being able to participate in physical activity on a regular basis?*
Prior to participating in We Roll, how long had it been since you participated in an organised sport program / activity outside of school?*
If you have participated in organised sport outside of school in the last 12 months, how often was this?
This question to be completed by the Skater only. Do you agree or disagree with the following statement relating to the way in which we view ourselves? The statement is 'I feel connected with others'.
Have you played / participated in Roller Skating / Roller Sport (at a club) before?*
Have you played / participated in Roller Skating / Roller Sport (at a rink or just for fun) before?*
GROUP DYNAMIC
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. Please complete all questions as they relate to PARTICIPANT 3.
Where were you born?*
If born overseas, how many years in total have you lived in Australia?*
Are you of Aboriginal or Torres Straight Islander origin?*
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?*

Save and Continue Later

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carlton baths

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