Registration Form
Last Name *
Your answer
Given Name *
Your answer
Gender
Mailing Address *
Your answer
Town *
Your answer
Postal Code
Your answer
Birthday *
MM
/
DD
/
YYYY
Parent/Guardian Name *
Your answer
Relationship *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Emergency Contact
Your answer
Phone Number for Above
Your answer
Siblings Registered *
Health Card Number *
Your answer
Medical Questionnaire Section
This section will be for the inclusion of medical conditions such as epilepsy, ADD/ADHD, prosthetic limbs etc as well as any allergies that your child might have so the club can be aware of them. We use this information privately so as to allow us to provide necessary support for your child during their classes. If there is no conditions or allergies, Please just put no in the section. Thank you
Allergies *
Your answer
Medical Conditions *
Your answer
WAIVER AND INITIALS
I AM AWARE THAT RR GYMNASTICS & TRAMPOLINE CLUB GIVES SPECIFIC PERSONAL INFORMATION TO GYMNASTICS NOVA SCOTIA FOR REGISTRATION PURPOSES ONLY. GYMNASTICS NOVA SCOTIA MAY THEN PROVIDE SPECIFIC INFORMATION TO GYMNASTICS CANADA FOR REGISTRATION OR COMPETITION PURPOSES ONLY. RR GYMNASTICS & TRAMPOLINE CLUB DOES NOT SELL OR DIVULGE PERSONAL INFORMATION TO ANY OTHER SOURCE OTHER THAN THAT REQUIRED FOR A MEDICAL EMERGENCY WITH PARENT OR GUARDIAN'S CONSENT.
AS A PARENT/GUARDIAN OF THE ABOVE NAMED APPLICANT, I HEREBY GIVE MY CONSENT FOR HIM/HER TO PARTICIPATE IN THE RR GYMNASTICS & TRAMPLOLINE CLUB PROGRAM AND CERTIFY THAT HE/SHE IS PHYSICALLY FIT TO TAKE PART IN ALL ACTIVITIES. FURTHER, I DO HEREBY WAIVE, RELEASE AND FOREVER DISCHARGE SAID ORGANIZATION, STAFF, AND VOLUNTEERS FROM ANY AND ALL CLAIMS FOR DAMAGES AND/OR INJURIES OCCURRING DURING RRGYMNASTICS & TRAMPOLINE CLUB ACTIVITIES. I ALSO CONSENT FOR THE RR GYMNASTICS & TRAMPOLINE CLUB TO PROVIDE OR OBTAIN EMERGENCY MEDICAL TREATMENT FOR THE ABOVE NAMED PARTICIPANT IF NECESSARY.
Previous Level *
Picture/Name Waiver *
MAY WE USE YOUR CHILD'S NAME/PICTURE IN NEWSPAPER ARTICLES OR PROMOTIONS?
PARENT INITIALS *
PLEASE INITIAL IF YOU SUBMIT THAT THE INFORMATION YOU PROVIDED IS CORRECT
Your answer
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