2021 Baton Atlantik WINTER Registration Form

2021 WINTER REGISTRATION FORM

2021 Winter Session will begin the week of January 11th
Registration form must be received before attending classes.

Receive a ballot for a chance to WIN a $50 gift certificate if form and full payment is received between January 2nd and January 9th.

A 10% late fee on balance owing will be added after January 31st.
Athlete's Name *

First Name Last Name
Mailing Address *

Street Address

Street Address Line 2

City Province

Postal Code
Date of Birth *
Day
Date of Birth *
Month
Date of Birth *
Year
Home Number

Area Code Phone Number
Mother's Name *
Cell Number

Area Code Phone Number
Father's Name
Cell Number

Area Code Phone Number
Guardian's Name
Cell Number

Area Code Phone Number
E-mail
E-mail
example@example.com
Twirlers' E-mail
example@example.com
RECREATIONAL AND NEW MEMBERS - please click the class(es) you wish to enroll in:

Tuesdays 6:00 to 7:00 (1542 Champlain Street in Dieppe) Wednesdays 6:00 to 7:00 (1542 Champlain Street in Dieppe) Thursdays 6:00 to 7:00 (Saint-Antoine Community Centre) Sundays 12:30 to 1:30 BADGE PROGRAM (1542 Champlain Street) Sundays 1:30 to 2:30 ACROBATICS (1542 Champlain Street)
PRE COMPETITIVE - please click the class(es) you wish to enroll in:

Tuesdays 6:00 to 8:00 (1542 Champlain Street in Dieppe) Wednesdays 6:00 to 7:00 (1542 Champlain Street in Dieppe) Thursdays 6:00 to 8:00 (Saint-Antoine Community Centre) Sundays 12:30 to 1:30 BADGE PROGRAM (1542 Champlain Street) Sundays 1:30 to 2:30 ACROBATICS (1542 Champlain Street)
COMPETITIVE - please click the class(es) you wish to enroll in:

Tuesdays 6:00 to 8:00 (1542 Champlain Street in Dieppe) Tuesdays 7:00 to 9:00 (1542 Champlain Street in Dieppe) Thursdays 7:00 to 9:00 (Saint-Antoine Community Centre) Fridays 6:00 to 8:00 (1542 Champlain Street in Dieppe) Fridays 8:00 to 9:00 (1542 Champlain Street in Dieppe) (Compulsories/Freestyle/Pair) Sundays 12:30 to 1:30 BADGE PROGRAM (1542 Champlain Street) Sundays 1:30 to 2:30 ACROBATICS (1542 Champlain Street)
ALL STAR TEAMS - please click the class(es) you wish to enroll in:

Wednesdays 7:00 to 9:00 (1542 Champlain Street in Dieppe). We are looking to add more teams in 2021. If you are competitive JOIN US!
Fees and number of hours based on 10 weeks: *

1 Class (1 hour) per week $120 plus tax 2 Classes (2 hours) per week $215 plus tax 3 Classes (3 hours) per week $300 plus tax 4 Classes (4 hours) per week $370 plus tax 5 Classes (5 hours) per week $425 plus tax 6 Classes (6 hours) per week $480 plus tax 7 Classes (7 hours) per week $525 plus tax 8 Classes (8 hours) per week $560 plus tax Combo Deal Choice of 8 classes offering the 9th class free 10 Classes (10 hours) per week $650 plus tax 11 Classes (11 hours) per week $715 plus tax
NEW members must purchase the yearly membership. Returning members must check other in order to proceed *

Recreational Baton NB Yearly Membership (no tax) $17 NEW MEMBERS ONLY Pre Competitive Baton NB Yearly Membership (no tax) $22 NEW MEMBERS ONLY Competitive Baton NB Yearly Membership (no tax) $45 NEW MEMBERS ONLY New baton $40 plus tax 2nd member of the same family $20 credit 10% late fee will be added to any balance owing after January 31st midnight
Total Amount
Agreement for Participation

I understand that baton twirling classes may include, without limitation, twirling, dancing, stretching, acrobatics, routines, and other related activities. I further understand that all of the activities of the baton twirling class involve some degree of risk of strain or bodily injury. Club Baton Atlantik is not responsible for personal property. I hereby acknowledge that I have read the statements above and agree to participate accordingly.

Media Consent - Photography/Media/Social Media 2020-2021 Season

During the year, photographs of athletes may be taken during competitions, clinics, awards, performances, parades, recitals or other occasions. Your consent is required or Parental/guardian consent if the athlete is under the age of majority. Media coverage is occasionally done throughout the competition season in order to promote the sport of Baton Twirling and to acknowledge club and athlete's accomplishment. This means publishing of athlete's names and club in the local newspapers and other social media. Do you grant the Club Baton Atlantik permission to post all forms of publicity including full name and image?
*

YES, permission is granted NO, permission is not granted
Signature *

Clear
COVID-19 Assumption of Risk & Liability Waiver

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, provincial, and local governments and local health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. Club Baton Atlantik has put in place preventative measures to reduce the spread of COVID-19; however, the Club cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Club could increase your risk and your child(ren)'s risk of contracting COVID-19.
By checking the boxes and signing this agreement, you acknowledge the contagious nature of COVID-19 and voluntary assume the risk that your child(ren) and yourself may be exposed to or infected by COVID-19 by attending the Club and that such exposure or infection may result in personal injury, illness, permanent disability, and death. *

I understand that the risk of becoming exposed to or infested by COVID-19 at the Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club employees, volunteers, and program participants and their families I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind that I or my child(ren) may experience or incur in connection with my child(ren)s attendance at the Club or participating in Club programming ("Claims"). On my behalf and on behalf of my children I hereby release, covenant not to sue, discharge and hold harmless the Club, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participating in any Club program.
Full Name *

First Name Last Name
Today's Date

Month Day Year
Date
Your Signature *

Clear
Should be Empty:

2021 WINTER REGISTRATION FORM