Illusions Winter Guard Registration Form

Illusions Winter Guard Registration Form

Register a youth for the group and provide parent/guardian, payment, consent, signature, insurance, and medical information.
Youth Information
Youth Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Age
Email Address
example@example.com
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Parent/Guardian Information
Parent/Guardian Full Name

First NameLast Name
Relationship to Youth
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Medical Information & Treatment Authorization

Complete the information below which will be shared only with the Executive Staff for the purpose of ensuring participant safety. In the event of an emergency where a parent/guardian cannot be reached, I hereby authorize the Guard Director and/or designated staff to seek emergency medical treatment for my child.
Medical Conditions to Be Aware Of
Allergies
Acknowledgment Checklist
Emergency Contact Information

Please provide the details of someone other than a parent/guardian
Name

First NameLast Name
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Previous Performance Experience

Previous experience is NOT required to join Illusions Winter Guard — all skill levels are welcome! This information helps us plan training and placement.
Does the member have experience with any of the following?
Code of Conduct & Rowan's Law

Please read the document below to understand and agree to the Member Code of Conduct and Concussion Awareness and Protocols for as directed by Rowan's Law. The attached document is a modified version, the full documents are available for any staff, member, board of director or parent review in our Governance Handbook.
Waiver of Consent to Participate
Acknowledgment Checklist
Photo, Video, Social Media & Communication Consent

Illusions Winter Guard may photograph and/or video record members during rehearsals, performances, competitions, and events for use in promotional materials, social media, the group's website, and community publications.
Acknowledgment Checklist
Parent/Guardian Signature
Date Signed

MonthDayYear
Date
Registration Fees

NEW MEMBER ONE-TIME REGISTRATION FEE: $150.00 per member. The initial registration fee will cover your membership t-shirt, guard gloves and performance shoes. This fee does not apply to members who are renewing their membership.
Payment Details

Upon submitting your payment denotes approval of the system saving your payment information for the purpose of the monthly payment option or yearly membership renewal. Members can revoke their permission to renew their membership 30 days prior to the yearly renewal date.
Monthly Dues & Optimist Member Fees

All members must pay monthly dues of $50 by auto-withdrawl from a registered bank account. Illusions Winter Guard is a registered Optimist International member and therefore must remit fees on a yearly basis. Your monthly dues ensures that all operating costs, equipment costs, insurance fees, and Optimist International fees remain in good standing. Monthly fees are non-negotiable. The rate of the fee is subject to change each year.
Fee
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Registration Fee
One-time initial registration fee for Illusions Winter Guard. One tshirt, guard gloves and performance shoes are included. Ongoing monthly dues of $50 will be set up as an auto payment commencing on the second month of membership until the member resigns from the club.

$150.00 CAD SizeShoe

Total

$0.00 CAD
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Illusions Winter Guard Registration Form

Youth Information

Parent/Guardian Information

Medical Information & Treatment Authorization

Emergency Contact Information

Previous Performance Experience

Code of Conduct & Rowan's Law

Waiver of Consent to Participate

Photo, Video, Social Media & Communication Consent

Registration Fees

Payment Details

Monthly Dues & Optimist Member Fees

Fee*

Fee