Youth Course Registration Form

Participant Registration Form

Please complete the form below to register for our Youth Courses.
Participant's Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Current Grade*
Address

Street Address

CityProvince

Postal Code
Parent/Guardian Information
Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Courses
Please Select Course Below:
Please select all courses:*

Youth Workshop- Tuesday March 11 **FREEBabysitting Course- Wednesday March 12Stay Safe (Home Alone)- Wednesday March 12Youth First Aid- Thursday March 13
Additional Participants
Please note- this section is ONLY for participants from the same family, in the SAME course.
Notes (ex: please list other participant names if your child would like to attend with a friend)
Lunch will be provided for the Youth Workshop ONLY *Please list any dietary restrictions or food allergies below.
Medical Information
Is there any medical Information/allergies of which the instructor should be aware?*

YesNo
If yes, please list medications that must be brought with the participant:
Photo Release Waiver
I hereby grant permission to Aquatic Adventures and/or Flex First Aid and its associated organizations to take photographs and/or videos of my child, during their participation in any course, at any facility being used for programming. I understand that these photographs and/or videos may be used for the purpose of publication, promotion, or any manner in any medium, including but not limited to Aquatic Adventures and/or Flex First Aid websites, social media pages, and advertisements.
Waiver/Confirmation
I hereby release Aquatic Adventures/Flex First Aid from all claims for damages rising from participation of the applicant hereon during any program or in any facility or at any location where a program is being held.
By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
Signature*

Clear
Should be Empty:

Participant Registration Form

Parent/Guardian Information

Courses

Medical Information

Photo Release Waiver

Waiver/Confirmation