Registration form Rhapsody RG Fredericton Gymnaestrada Teen & Adult

Rhapsody RG Fredericton Registration GYMNAESTRADA

For Teens, Adults and Seniors. All inclusive. No experience necessary. Saturdays, 2:00-3:30pm
Participant name*

First NameLast Name
Participant or Parent (Guardian) Phone Number*

Area CodePhone Number
Participant or Parent (Guardian) E-mail*
example@example.com
Birth Date*

DayMonthYear
Gender*
Medicare and expiry date*
Allergies/special needs*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact Name*

First NameLast Name
Emergency Contact E-mail*
Emergency Contact Phone Number*

Area CodePhone Number
WAIVER*

In consideration of acceptance of registration, I agree that I will not hold "Rhapsody" Rhythmic Gymnastics, its staff and volunteers responsible for personal injuries, property loss or damage while involved in club activities. I will accept financial responsibility for the replacement cost of any club equipment lost, stolen or damaged while in my or my child's possession. I understand that my child or I may be photographed and videotaped during classes and other special events. I give permission to Rhapsody Rhythmic Gymnastics to publish my name or my child’s: name, picture and video in the newsletter, flyers, on the club’s web site, Facebook page and use it for any other publicity or professional purposes.
WAIVER*

In the event of an emergency, "Rhapsody" Rhythmic Gymnastics staff and/or volunteers will first attempt to notify the emergency contacts or the parent/guardians. Should immediate medical attention be required, "Rhapsody" Rhythmic Gymnastics staff and/or volunteers may transport my child to emergency facility and/or administer first aid.
Special comments:
How did you hear about us?*
Date*

MonthDayYear
Participant or Parent (Guardian) signature*
For organization use only
Start date

MonthDayYear
Should be Empty:

Rhapsody RG Fredericton Registration GYMNAESTRADA