STAFF REGISTRATION

New Staff Registration Form

Contact

Name

First Name

Last Name

Date of Birth

DD/MM/YYYY

Phone

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Medical History and Other information

Medicare Number:

Medical Conditions:

Allergies:

Injuries:

Medication:

Please supply Asthma, or Anaphylaxis action plan below

Parent / Partner / Alternate Contact Name

First Name

Last Name

Relationship

Phone

Tax File Number

For Taxation purposes - is this your primary place of employment

Banking Details

Name of Bank

BSB Number

Name on Account

Account Number

Gymnastic Australia Technical Membership Number

Working With Children Check Number

Working With Children Check Expiry

Superannuation - Name of Company

Superannuation - Membership Number

Any Other Info that you would like us to be made aware of: