2024 Individual Member Registration Form
CAMDEN UNITED PHYSIE & DANCE
Full Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Contact Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
2024 Age Group
*
Please Select
3-4 Years
5-8 Years
9-12 Years
13-17 Years
Seniors (17+)
Ladies (25+)
Unsure
What year did you join CUPAD?
*
Have you had any breaks?
*
Yes
No
If yes, how many years?
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about us?
*
Please Select
Family / Friends
Social Media
Google / Internet
Banner
Other
Photographic Consent
Permission for CUPAD to print daughter’s/member’s photo(s) on publications (e.g. flyers, brochures, programs).
*
Yes
No
Permission for CUPAD to post daughter’s/member’s photo(s) on website or social media.
*
Yes
No
Financial Commitment
Please tick:
*
I understand that classes are $5 each for 3-4 years, and $10 each for members 5 years and older.
I understand fees are charged per term.
I understand that fees are due by week 3 of each term.
Signature
*
Parent / Guardian / Member
Date
*
-
Day
-
Month
Year
Submit
Should be Empty: