Recreational Registration Winter 2020

Please select class (required):

Saturdays Feb 1-Jun 13,2020 10:00 am-10:50 am @ WHC*Sundays Feb 2-Jun 14,2020 3:00 pm-3:50 pm @ BHPCC*

ATHLETE INFORMATION:

Athlete Name (required):

Date of Birth (required):
(mm/dd/yyyy)

Age (required):

Medical Issues or Concerns:

PARENTS/GUARDIANS INFORMATION:

Parent/Guardian#1:

Name (required):

Cell (required):

Occupation(required):

Email (required):

Mailing Address (required):

Postal Code (required):

Home Phone (required):

Parent/Guardian#2:

Name (required):

Cell (required):

Occupation(required):

Emergency contact:

Name (required):

Phone (required):

__________________________________________

How did you hear about illusions? (required)
—Please choose an option—FacebookInstagramFriend ReferralGoogle SearchOther

__________________________________________

I have read MEDIA RELEASE FORM and give Illusions Rhythmic Gymnastics Club (Illusions) permission to use and publish, for promotional purposes by any means, including but not limited to, the Illusions website, Facebook page and for media release, and on any number of occasions:

Photographic and Digital Images of meVideo images of meI do not give permission

__________________________________________

I have read and agree to the terms presented in the WAIVER OF LIABILITY

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