LIT Fun Night
7 weeks of fun getting to know your fellow LITS!
Registrant's Name *
Your answer
Registrant's Age *
Your answer
Parent's Name *
Your answer
Email *
Your answer
Address *
Your answer
Phone number *
Your answer
Emergency Contact *
Your answer
Custody Arrangements (if applicable)
Your answer
Allergies/Medical Conditions
Your answer
Behaviour/Communication (any strategies or methods that would help your child succeed at this event/program):
Your answer
I understand that the Grange Hill East Neighbourhood Group Staff reserve the right to dismiss a participant who, in their opinion, is a hazard to the safety or rights of others, or who appears to have rejected the reasonable expectations of the program *
Required
To the best of my knowledge my child is in good health. If there is any exposure to any infectious disease and/or change in my child’s condition prior to attending program, I will notify the office staff immediately *
Required
I agree to indemnify (insure against loss) Grange Hill East Neighbourhood Group, the Guelph Neighbourhood Support Coalition and their agents, employees, members, directors and officers for any kind of liability, howsoever incurred or caused during the stay of the members listed below on or off site. *
Required
I further agree and understand that the Grange Hill East Neighbourhood Group, The Neighbourhood Support Coalition and their agents, employees, members, directors and officers shall not be responsible or liable for: any loss or damage of any kind to the property whatsoever however caused; and any injury to any person however caused
I give permission for my child to go off-site to areas within walking distance during this event/program (ie. local park, etc.) *
I give permission for photographs and videos of my child to be used for promotional purposed by Grange Hill East Neighbourhood Group and/or the Guelph Neighbourhood Support Coalition
This program is being offered at $10. Please let us know how you would like to make payment below. For subsides, please contact Jen at info@gheng.ca
Parent Signature/ Date *
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