2024/2025 Taekwondo Registration

2024/2025 Taekwondo Registration

Program runs on Thursdays from September 12, 2024 - June 24, 2025 (does not include P.A. Days or March Break)
Participant Information
Are you a registered Kerr Street Family, a member of our Kids' Clubs or of our Youth Program?*

YesNo
Unfortunately you must be a registered KSM Client, a member of our Kids' Club or a member of our Youth Program to participate. For more information on how to do that please email admin@kerrstreet.com or call 905-845-7485.

Back to website.
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Home Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Does your child use an epi-pen, medication or have any allergies, dietary restrictions, sensitivities or other special needs? Is there any important information for staff and volunteers to be aware of?*

YesNo
If “Yes” please explain and provide a specific treatment plan if necessary.*
Do you already have a Taekwondo uniform from Kids' Club?*

YesNo
Parent/Guardian Information
Parent/Guardian 1 Name*

First NameLast Name
Daytime Phone*
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Email*
example@example.com
Alternate Emergency Contact
Emergency Contact Name*

First NameLast Name
Relationship to Participant*
Daytime Phone*
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Permission and Waiver
I, {parentguardian1} (the PARENT), am the parent/legal guardian of {childsName} (the PARTICIPANT), who has my permission to attend and participate in the Taekwondo program run by Kerr Street Community Services, operating as Kerr Street Mission located at 485 Kerr Street, Oakville. I have read and completed the application and confirm all information is correct.

THE PARTICIPANT hereby agrees to abide by the behavioral guidelines for the program and the parent agrees that in the event that the PARTICIPANT fails to comply with the guidelines or behaves in such a way as is likely to cause damage or injury to persons or property while at camp, the PARTICIPANT may be sent home at the parent’s expense and the parent shall be responsible for any costs incurred in rectifying any damage.

THE PARENT hereby authorizes the administration of any first aid treatment that may be deemed necessary by any of the Kerr Street Mission staff. In the event of a more serious medical emergency affecting the PARTICIPANT, the staff shall make all reasonable efforts to contact the parent/guardian. Where attempts to contact the parent are not successful or are not feasible due to the urgency of the situation, the staff are hereby authorized to obtain the services of a duly licensed physician and to secure appropriate treatment for the PARTICIPANT. The parent hereby confirms that the PARTICIPANT is covered by OHIP or equivalent medical insurance.

THE PARENT AND THE PARTICIPANT hereby acknowledge that there are inherent risks involved in the group activities which comprise the program, and voluntarily elect to assume said risks as their sole responsibility. The parent and the PARTICIPANT hereby release Kerr Street Community Services employees, agents, board of directors, volunteers from any and all liability, claims, damages and costs for loss, personal injury, accident, misfortune or damage to the PARTICIPANT or his/her property while participating in events sponsored by Kerr Street Mission. It is understood that Kerr Street Mission shall take reasonable precautions to provide for the health and safety of the PARTICIPANT.
I AUTHORIZE the use of any photos taken over the duration of the program for non-profit promotional purposes.*

YesNo
BY SIGNING BELOW I ACKNOWLEDGE having read and understood each of the foregoing provisions and KSM policies and agree to abide by the terms of this agreement, authorization and waiver.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

2024/2025 Taekwondo Registration

Participant Information

Parent/Guardian Information

Alternate Emergency Contact

Permission and Waiver