Program Registration Form

ORIGAMI RHYTHMICS

GYMNASTICS CLUB

Athlete’s

Information

First name:

Last Name:

Date of birth:

Home Address:

Home phone number:

E-mail:

School Gym/Dance

Experience:

Care Card #:

Family Doctor and

His/her phone number:

Physical Concerns (any No

Health issues and/or

allergies, any medications

that child is taking regularly):

If Yes, please describe in

details:

Emergency Contact

Number:

How did you find out

about our club:

Parents Contact

Info:

Mother’s name:

Mother’s Phone Number:

Father’s name:

Father’s Phone Number:

Waiver Form

In consideration of your acceptance of my child’s registration, I agree that Origami Rhythmics gymnastics club (“Origami Rhythmics”) and its instructors, coaches, directors, officers and contractors shall not be liable for any claim, demand, cause of action of any kind whatsoever for, or on account of personal injury, property damage or loss of any kind resulting from or related to my child’s use of the facilities or participation in any program, exercise or activity within or outside the premises, including transportation, and I agree to the Origami Rhythmics gymnastics club (“Origami Rhythmics”) and its instructors, coaches, directors, officers and contractors to

hold harmless from same.

Parent/Guardian Date:

Signature ____________________________

Photo/Video Consent

I will allow photos/videos taken of my child at club events to be used in future advertising (publishing them on Origami Rhythmics website: www.origamirhythmics.com and/or local Newspapers) – Yes

Please note: No participation will be allowed without the completed and signed Registration Form.

· Please date cheques for the 1st day of each month

· Ensure that cheques beginning in January are dated 2018

· Make cheques payable for Origami Rhythmics

· Complete Registration Form after saving it on your computer desktop and send it by e-mal: or alternatively complete the form and send it by mail with payment to the Origami Rhythmics Mail Address: 10390 244St., Maple Ridge, BC, V2W 2G3

· Receipt for tax purposes will be provided once a year upon your request.