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Program Registration Form
Sign in to Save Progress
This form has been modified since it was saved. Please review all fields before submitting.
Please use cheque or money order for mail-in or drop-off registrations. Make cheques payable to the City of Beaumont. Registration and a signed waiver required for all programs.
Surname
Parent / Guardian Name
Address
Postal Code
Home Phone Number
Work / Cell Phone Number
Email
Where did you hear about the program?
Website
Brochure
Newspaper
Friend
Other
Other
Participant Name
Birth Date
Birth Date
Male / Female
Program
Date / Time
Date / Time
Date / Time
Fee
Participant Name
Birth Date
Birth Date
Male / Female
Program
Date / Time
Date / Time
Date / Time
Fee
Participant Name
Birth Date
Birth Date
Male / Female
Program
Date / Time
Date / Time
Date / Time
Fee
Participant Name
Birth Date
Birth Date
Birth Date
Male / Female
Program
Date / Time
Date / Time
Date / Time
Fee
Participant Name
Birth Date
Birth Date
Birth Date
Male / Female
Program
Date / Time
Date / Time
Date / Time
Fee
Allergies
Medical Considerations
Gymnastics badge last received:
If the course if full, I would like to:
Remain on the Waiting List
Have a Refund Mailed
Register in an Alternative Course
Waiver for Activities
The following Waiver for Activities must be completed before attending any program.
I give permission for myself/my child(ren) to participate in the above noted program. I understand the nature of the activity, the limited supervision provided and that there are inherent risks associated with this activity and that I or my child(ren) could sustain personal injury through participation in this activity and I am hereby accepting to take that risk on behalf of myself or my child(ren). I hereby agree to save harmless and indemnify the City of Beaumont, its organizers, agents or employees against claims, expenses and demands in respect to injury or death arising out of myself or my child(ren) taking part in this activity but limited to taking part in this activity.
Child's Name(s)
Signature of Participant / Parent or Guardian (if under 18)
Witness
Date
Date
The personal information requested on this form is being collected under the authority of the City of Beaumont Bylaw 382 and Section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act. The information collected will be used as for the purpose of setting up utility billing.
If you have any questions about the collection or use of your personal information, contact the City of Beaumont’s FOIP Coordinator at:
City of Beaumont's FOIP Coordinator
5600-49th Street
Beaumont, AB T4X 1A1
Phone: 780-929-8782
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