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Registration Form

Artistic Recreation Program

The following participant information is collected by GBC for it's own use and must be completed to be properly registered.
First Name   Last Name  
Birthdate*      Age    Home Phone   
Mailing Address  
City    Postal Code  
Email Address        
The following participant information is collected by GBC on behalf of your club which retains control and custody of it for safe emergency purposes.
BC Medical Number     
Medical Info  
i.e.: allergies, medical conditions,
ADHD, epilepsy, etc.
Parent/Guardian    Relationship     Phone  
Emergency Contact
(other than Parent/Guardian)  		   Relationship     Phone  
I HAVE READ THE MINOR RELEASE STATEMENT/ADULT WAIVER AND AGREE WITH THE TERMS
Classes are filled on a first come first served basis. Classes are limited in size; please indicate your 1st and 2nd choice from schedule provided. Indicate in other section if there is a preferred day and time not shown on schedule. Although we cannot guarantee that you will get your choices, every effort will be made to accommodate your request. Please select your preferred days and times:
1st: Day: 
Time: 
2nd: Day:
Time:
Medical Authorization
I authorize Springers Gymnastics Adventures and its staff to provide all emergency medical care, which they may deem necessary for my child as the case may be, in the event of an injury. I agree to reimburse 'Springers Gymnastics Adventures' for any expenses thereby incurred.

Behavior and Conduct
I hereby acknowledge that my child will act in accordance with the Springers Gymnastics Adventures rules and regulations and participate in an appropriate and reasonable manner at all times. Should Springers Gymnastics Adventures and their staff determine, at their sole discretion, that my child's actions are inappropriate, my child will be released from the Springers Gymnastics Adventures Program immediately. A partial refund, less $15.00 Administration Fee will apply.
Name of legal Guardian   Date (yy/mm/dd)