BDC Registration Form 2016-2017
This form is intended for members who prefer to make cash payments instead of using our online form and CC payment through PayPal option provided on the website. To be able to register using this form, you need to send us an email to guarantee your spot after you fill the form : boysdadsclub@gmail.com. Please read the club rules and bring your payment on the first day of club meeting. For more info and dates, check our Calendar listed under documents on our website.
BDC 2016-2017
Child Full Name
Your answer
Child DOB
Your answer
Child Age ( Only 8-14 Yrs by Sept 30, 2016)
Your answer
Child Email
Your answer
Child Phone #
Your answer
Father Full Name
Your answer
Father Email
Your answer
Father Phone #
Your answer
Child Home Addres
Your answer
Mother Name
Your answer
Mother Email
Your answer
Mother Phone#
Your answer
Emergency Contact Full Name
Your answer
Emergency Contact Phone #
Your answer
Emergency Contact Phone #
Your answer
Does your child have any medical conditions or food allergies that we should be aware of? if yes, please give us details:
Your answer
I consent to the above named member being able to take part in activities arranged by the boys and Dads Club and confirm that I am responsible for my child's safety whilst travelling to and from the club. I release the club and ICGC from any and all laibility regarding property damage, personal injury, or other claims arising from or in connection with your participation in the program
Required
I consent to my child being transported to the nearest hospital in case of emergency
Required
I will allow photographs of my child and myself to be used in the ICGC and BDC Publicity and media
Required
I have read and understood the club rules ( find them on the website) and i will ensure my child and I will abide by them
Required
Parent signature and Date
Your answer
I will submit the payment of $100 in cash to the club administrator on the first day of the club.
Required
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