GYMNASTICS CLUB

Registration Form 2008/2009 Season

Participant’s First Name Last Name

Age Birthday Gender: M F .

Parent(s) Name(s)

Address

Phone # (Home) (Cell)

(Work)

Email Address

Emergency Contact Name Phone #

Care Card #

Doctor Name Doctor Phone

Medical Information (relevant to the activity special needs, allergies, etc…)

Program Registering for:

q Competitive Interclub Provincial

Number of hours training per week:

q Recreational Last CANGYM Lv. Completed

Class Day and Time

q Kindergym Class Day and Time

Method of Payment

q Full session payment by check or cash. Amount $

q Competitive team/interclub only Sept check and monthly postdated checks for Oct-June

Date Parent Signature

o I do not want my child’s name or picture used