Youth Programs Registration Form

							         Youth Programs Registration Form
                                  Learn To…Kayak
                                   Oct 23rd, 2009
                            7-9pm Nick Smith Centre Pool
                            Registration Cost: $25/youth
                                      Ages 9-17

This program is taught by Wilderness Tours and Ottawa Kayak School in the
  pool. All equipment will be supplied. This program is Get Fit! certified.

To Bring:       -Swim Suit
                -Life Jacket (if you want)

Full Name of Youth: __________________________________

School: ____________________________________________

Grade: ______________              Date of Birth:__________________

Payment Method:         Cash             Cheque

Swimming Ability:               Can’t Swim               Beginner         Frequent Swimmer

Allergies/Medical Needs: _______________________________
*Please include any food allergies, whether it is severe or not
*Please include any other allergies/medical needs that our staff and volunteers need to know
about

Parent/Guardian Name: ________________________________

Phone Number: ______________________________________

Alternate Number: ____________________________________

Height: ________________                 Weight: _______________

I, the undersigned, do hereby release and agree to indemnify and save harmless Arnprior Parks
     and Recreation Department, The Corporation of The Town of Arnprior and their respective
 officers, volunteers, employees, or agents and each and every Board and Commission thereof,
     from all claims for loss, injury or damage, to persons and property while participating in or
   traveling to and from the above activity, which I, or any person claiming through me or on my
   behalf, may at any time have arising out of or connected with the operations of this activity. I
   understand that should my child misuse the equipment, I will be responsible for replacement
                                             and/or repairs.



____________________________                             _______________________
    Signature of Parent/Guardian                                          Date

The cost of this program, along with all youth programs, is to cover costs associated with the
               program. Any profits are directly put into other youth programs.