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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
Male
Female
Birthdate
*
Day
1
2
3
4
5
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7
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10
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25
26
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28
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30
31
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
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1989
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1962
1961
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1958
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1956
1955
1954
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1952
1951
1950
1949
1948
1947
1946
1945
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)