KRSG's Adult Recreational Registration Form

Adult Recreational Registration Form

To register with the KRSG club please out the form below.

If you have any problems, please e-mail the Program Coordinator.

Your registration is not complete until we receive your cheque to cover the registration fee.
Spots will be allocated on a first come, first served basis only.

Experience

Session Information	Please check our schedule for available class times.

Class:	Preferred Day/Time:

Gymnast's Personal Information

Last Name:	First Name:	Age:

Name Commonly Used: (if different from above)	Birth Date:

Street Address:

City:


Province Postal Code:	Home Phone: ()

Primary Contact
In the event of an emergency, KRSG will attempt to reach the primary contact first. Information from KRSG will be sent to the primary contact via email.

Last Name:	First Name:

Day Phone: ()

Evening Phone: ()

Mobile Phone: ()

Email address:	Relationship to Gymnast:

Secondary Contact

Last Name:	First Name:

Day Phone: ()

Evening Phone: ()

Mobile Phone: ()

Email address:	Relationship to Gymnast:

Where did you hear about the Club?

Recommendation from a friend
Website
Community Newspaper
Name of Paper
Open House
Registration Day at Mall
Other
Details

Medical Information

Are there any medical, family circumstances, or religious requirements of which the coach should be aware?

Yes No

If yes, the coach will arrange a private interview.

Parent/Guardian Consent of Participation and Waiver

	By checking the box to the left and submitting this form, I acknowledge that I am aware that there are risks associated with gymnastics. I warrant that the participant named on this information form, is physically fit to participate in gymnastics. I declare that I have accurately disclosed all information regarding physical, mental or medical conditions affecting the named participant and acknowledge that this information may be used for Kanata Rhythmic Sportive Gymnastics (KRSG)/ Gymnastics Ontario’s (GO) use in the delivery of a gymnastic program. I acknowledge that there is potential risk for injury involved in training and competing in any sport. I understand that GO has tried to create a safe and controlled environment for participation and that KRSG has established rules for participation on and about the gymnastic area that must be followed by the participant. I understand that failure to comply with any of the policies and rules of KRSG and/or GO may result in the suspension or termination of membership. I waive the rights of the participant to damages or other costs in the event injury is caused due to participation in gymnastics or other involvement with the KRSG Club and/or GO.

	By checking the box to the left and submitting this form, I hereby give permission for emergency medical treatment to be administered to me as may be determined in the reasonable discretion of the Personal Coach/Team Manager. It is understood that whenever reasonably possible, relatives will be contacted and informed of the problem, diagnosis; treatment required and anticipated medical results.

Photo/Video Release

By submitting this form, I hereby give permission for images of myself, captured during regular and special KRSG activities through video, photo and digital camera, to be used for the purpose of KRSG’s training techniques, website, promotional material and publications and waive any rights of compensation or ownership thereto.

KRSG Privacy Policy

By submitting this form, I acknowledge that I am aware and agree with KRSG’s privacy policy as stated below.

Registration Information Privacy Policy: The KRSG Club uses the information collected at registration for its own purposes associated with the operation of the club and its registration processes with Gymnastics Ontario. Information is not released to other third parties for any reasons without the written permission of the club members.

To facilitate distribution of information within the Club, Club Phone and e-mail lists are distributed to all members of the Club on a regular basis. These shall only be used for Club purposes and not distributed to other third parties

I understand that is my responsibility to ensure that the information on this form is kept current and I will notify the KRSG of any changes immediately.

When the SUBMIT button below is pressed, information entered above will be submitted to KRSG via standard e-mail over the Internet. If you prefer, you can print out the form and submit it via regular mail, sending it to Lynn Chen, KRSG Program Coordinator, 112 Moresby Drive, Kanata, ON K2M 2J6.

Last Updated on Monday, March 08, 2010