Pre STAR Classregistration Form

2017

Pre STAR ClassRegistration Form

PERSONAL INFORMATION

Participant’s Name: ______

Birthdate: ______Age: ______

Address: ______

Street Town Postal Code

Home Phone Number: ( ) ______Cell Phone Number: ( ) ______

Guardian’s Name(s): ______

E-mail Address: ______

Please measure length of participant's arm (from shoulder to finger tip): ______inches

Waiver Information

PRE STAR CLASSES - Participant's Assumption of Risk 2017 Session

Accidents can result from the nature of the activity and can occur without any fault on either the part of the athlete, or the Superstars Baton Club or its coaching and volunteering staff or the facility where the activity is taking place. By choosing to participate in the activity, you are assuming the risk of an accident occurring. The chance of an accident occurring can be reduced by carefully following the instructions of the coach at all times while engaged in the activity. If you choose to participate in baton with the Club you must understand that you bear the responsibility for any accident that might occur.

Untrained volunteers or staff may be involved in supervising this activity and that you shall accept the responsibility of observing your child's participation in this activity and should you have any objections to the manner in which your child or yourself are being supervised or instructed, you accept the responsibility to remove yourself or your child from the activity.

I am aware and understand that there are a number of inherent risks involved in my athlete’s participation in this sporting activity and are beyond the control of the Director/Head Coach and/or coaches of Superstars Baton Club, and/or host clubs and association (CNBTA, NBTA, TU) in which any competition and/or sanctioned activity in which my athlete participates, the host club(s), the event or competition director, the owner, occupier, operator, and/or tenant of the event facility, and any person, corporation or organization associated with the operation of such competitions or events. I further agree that I am assuming personal responsibility for any costs as well as any loss, damage, injury or ambulance service resulting from or in connection with such participation at each competition in which I and/or my athlete compete, or event in which I and/or my athlete participate. I have read and understand this Waiver.

______

Signature of Guardian DATE Superstars’ Director

Pre-STAR Class

Aug 2nd & 9thfrom 6-6:30pm - Fergus Center Wellington High School parking lot

Payment:Baton Deposit:

$20 for the program, paid by$30 for the baton kit, paid by

CashCash

Cheque (# )Cheque (# )

Deadline to register is July 28th. Please deliver form to:

Superstars Baton Club

890 Kelsowood Lane

Fergus, On

N1M 3R8