Safe Sport Champions Workshop Registration Form
Please provide all required information below:
Workshop Location:
*
Thompson (parents/coaches) @ R.D. Parker Collegiate - October 20 (evening)
Thompson @ R.D. Parker Collegiate - October 21 (full day)
Winnipeg @ Sport Manitoba - October 22 (full day)
Brandon @ Crocus Plains Regional Secondary School - October 23 (full day)
School Name:
Street Address Line 2
City
State / Province
Postal / Zip Code
School Phone Number:
.
Format: (000) 000-0000.
School Address:
Street Address
Street Address Line 2
Town/City
Postal Code
Postal / Zip Code
Principal:
Street Address Line 2
City
State / Province
Postal / Zip Code
Principal Signature:
School Contact:
Street Address Line 2
City
State / Province
Postal / Zip Code
School Contact Email:
List of Students/Participants & Staff that will be attending:
(maximum 6 students and 1 staff per school)
Participant #1
Name
Street Address Line 2
Grade
T-Shirt Size
Postal / Zip Code
Participant #2
Name
Street Address Line 2
Grade
T-Shirt Size
Postal / Zip Code
Participant #3
Name
Street Address Line 2
Grade
T-Shirt Size
Postal / Zip Code
Participant #4
Name
Street Address Line 2
Grade
T-Shirt Size
Postal / Zip Code
Participant #5
Name
Street Address Line 2
Grade
T-Shirt Size
Postal / Zip Code
Participant #6
Name
Street Address Line 2
Grade
T-Shirt Size
Postal / Zip Code
Teacher Supervisor (attending the full day event):
Name
Street Address Line 2
City
State / Province
Postal / Zip Code
Dietary Restrictions for Students/Participants or Staff:
Submit Registration
Submit Registration
Should be Empty: