Sibling Membership Form

Please note, we require you to submit one form per sibling.

Sibling Details
Name*
First Last
Nickname

Date of Birth*
DD slash MM slash YYYY

Age*

Gender*

Contact Details
Address*
Street Address Suburb State Post Code

Primary Contact Number*

Family Information
Adult A
Relationship to Child

Full Name*
First Last
Gender*

Contact Number*
Email*

Adult 2
Relationship to Child

Full Name
First Last
Gender

Contact Number
Email

Name of Sibling (Challenge Member / Patient)*

Sibling Interest and Personal Information
Likes (e.g. cars, concerts, art, etc)
Dislikes

Allergies

Dietary Requirements

Favourite AFL Club

Favourite Celebrities

Favourite Singers and Bands

Favourite Movies and TV Show/s

T-Shirt Size

Other Information
Is there anything else you think we should know?

Some Information to Note
The information provided in this Membership Form and all subsequent Brother/Sister Membership Forms will be stored on a database that resides at the Challenge office. This information remains highly confidential at all times, is viewed ONLY by Challenge Staff and will not at any stage be provided to a third party.

The information provided in this Membership Form and all subsequent Brother/Sister Membership Forms will only be used to invite the applicant and their family to attend Challenge activities and events.
As a Challenge Member, you will receive emails and flyers throughout the year informing you of upcoming events.

All Challenge activities and camps are provided FREE of charge and there are no obligations or commitments associated with becoming a member of Challenge.

If at any time, you wish to have your details updated or removed, please phone the Challenge office: (03) 9329 8474 or email: mail@challenge.org.au
I give permission for photographs taken by Challenge of my child and family members at camps, activity days and in hospital, to possibly appear in the Challenge e-newsletter, or events, in print, on tape or on film.
I give permission for photographs taken of my child and family members to possibly appear on the Challenge website, Facebook site or Challenge Social Media.
Please note, no names will be published online without your consent.
*
I, the legal guardian of the child in which this membership form is for, have read and understood how the information provided in this document is stored and used, and furthermore believe the information provided to be true and accurate at the time of signing.
Signature*

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