2024 TT4BH Programming

2025 Table Tennis 4 Brain Health Programming

January to March 2025
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
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
RELEASE and WAIVER of Liability, Assamptions of Risk, and Indemnity Agreement*

Agree
WITHDRAWL, Cancellation, Refund and Transfer Policy*

Agree
Player's / Participant's Medical Information

Be specific with all medical information
Does the player/participant have any allergies, asthma, or take any medications they will need to take during Table Tennis classes??*

YesNo
List all If you clicked Yes above
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 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 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.
Type Confirm*
By confirming you agree with above statement

2025 TERM 2 TT4BrainHealth Programming*

Saturdays 11:30am-12:30pm TT4BH classes $120.00CAD

SATURDAYS: January 11, 18, 25 February 1, 8, 15, 22, March 1, 8, 15 2025

Subtotal $0.00CADTax $0.00CADTotal $0.00CAD

Payment Methods

Credit Card

Apple Pay

Google Pay

Should be Empty:

2025 Table Tennis 4 Brain Health Programming

Player's / Participant's Medical Information

Payment Methods