2024 KIDS and YOUTH Programming

2024 KIDS Club and YOUTH Classes

September to December 2024
Player's Name*

First NameLast Name
Primary Email*
example@example.com
Player's Home Address*

Unit/house number

Street Address

CityState / Province

Postal / Zip Code
Players Date of Birth*

MonthDayYear
Date
Current School Attending*
Name of the school
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Relationship to the player*
Parent, Guardian, Family Friend, Grandparent, Relative ..
Which day and time is your child attending?*

Mondays 4-5pm Class FULL for Term 1Mondays 5-6pm Class FULL for Term 1Thursdays 4-5pm Class FULL for Term 1Thursdays 5-6pm IntermediateFridays 4-5pm Mixed LevelFridays 5-6pm Mixed Level classes
RELEASE and WAIVER of Liability, Assamptions of Risk, and Indemnity Agreement*

Parent/Guardian Agree
WITHDRAWL, Cancellation, Refund and Transfer Policy*

Parent/Guardian Agree
CODE OF CONDUCT Participant: I have read and understand the Code of Conduct attached. I agree to abide by it for the safety and enjoyment of myself and of other participants.*

Participant Agree
MEDIA PERMISSION *

YesNoOther
Player's / Participant's Medical Information

Be specific with all medical information
Does the player/participant have any allergies?*

YesNo
List all allergies and the type of reaction they cause
Does the player/participant have an epi-pen? If so, they must keep it with them at all times!*

YesNo
Does the player/participant have any special food restrictions?*

YesNo
Please list any special food restrictions
Does the player/participant take any medications they will take during Table Tennis classes?*

YesNoOther
IMPORTANT: All medications must be in the original package (daily sorters/pill keepers are not permitted.) Please only send medication for the class If needed at that particular time
Has the player/participant been diagnosed with asthma by a physician?*

YesNo
IMPORTANT: If your child has been diagnosed with asthma by a physician and has medication including tablets, nebulizers, or inhalers, they MUST bring such treatment with them to the class. If your child has an inhaler, they must keep it with them at ALL TIMES during Table Tennis classes.
Does the player/participant have any other important health history (heart condition, diabetes, any injury, mental - neurodiverse and/or physical conditions) or does the player/participant have any restrictions/medical conditions that the coaches need to be aware of?*

YesNo
Please list any medical history or conditions we should be aware of
I have read and understand ALL statements above and this medical release form. I understand that should a health problem arise, I will be notified but if I cannot be reached by telephone I consent to contacting the player's / participant's emergency contact person or 911 If necessary. I also consent to the release of information for medical purposes might any medical emergency arise.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number:*

Area CodePhone Number
Parent/Guardian Email Address:*
example@example.com

2024 TERM 1 KIDS Club and YOUTH Classes*

FRIDAYS 4-5pm Mixed Level classes$150.00CAD

FRIDAYS: November 15,22,29 December 6,13,20 2024

FRIDAYS 5-6pm Mixed Level classes $125.00CAD

FRIDAYS: November 22,29 December 6,13,20 2024

Mandatory YOUTH Membership 2024 2025$25.00CAD

NSTTS Annual Youth memberships September to September each year

Subtotal $0.00CADTax $0.00CADTotal $0.00CAD

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty:

2024 KIDS Club and YOUTH Classes

Player's / Participant's Medical Information

Payment Methods