Recreational Registration Winter 2020

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    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*

    *WHC is located at 115 Chain Lake Drive, Halifax, NS

    *BHPCC is located at 202 Innovation Drive, Bedford, NS

    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:

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    __________________________________________

    How did you hear about illusions? (required)

    Please specify:

    __________________________________________

    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:

    __________________________________________

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    Please note: if you having issues with date of birth format, please try to register using chrome browser or your mobile. sorry for inconvenience.

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