Youth Programs Registration Form
Shared by: pp00pp
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.