Belle Babes Registration Form

Belle Babes Registration : September 15, 2012

Apache Belles
P.O. Box 9020
Tyler, TX 75711

For questions, contact bellebabes@hotmail.com

Please fill out the form below:

Participant

First NameMiddle NameLast Name

Age

Birth Date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

E-mail

Girl's size

(select one)

Adult size

(select one)

Is the participant allergic to any food or drink that we need to be aware of?

Food or drink allergy:

Will the participant need to take any type of medication during the workshop?

Parent/Guardian

First NameLast Name

Emergency Phone

Area CodePhone Number

Physician's Name

Physician's Phone

Area CodePhone Number

Required permission

I certify that the above applicant has my permission to participate in the Belle Babes Workshop and performances. I authorize the director of the Apache Belles to act for me according to her best judgment in any emergency requiring medical attention. I hereby waive and release the Belle Babes Workshop and performance from liability for injury. I know of no mental or physical problems which affect my child's ability to safely participate in this workshop. I further certify that the above mentioned person has medical insurance in case of emergency.

Full Name

First NameLast Name