24-25 Club Detailed Registration Form

Club Registration Form
Student Information
Student's Name*

First NameLast Name
Birth Date

MonthDayYear
Child's Age*
What Grade your child in?*

6th grade7th grade8th grade
Gender*

MaleFemale
Parent/Guardian Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Number
Cell Number
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Which club will the student be participating in?*

Fast Dungeons and Dragons club(grade 6-8) $180
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*
I understand that I will be charged the club fee amount that's shown on the FAST website*
I understand that all payments will be made in person to Ms. Smith in cash, check, debit or credit card before the scholar can participate in any club*
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by {FAST} during the selected club.
Confirmation

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.
Date*

MonthDayYear
Date
Signature*

Clear
Should be Empty:

Club Registration Form