Recreational Registration Fall 2021

Please select class (required):

Rhythmic Minis (2016 & 2017): Sep 18 – Dec 18, 2021 (12 classes) 09:15-10:00am ($170)Rhythmic Stars (2012, 2013, 2014 & 2015): Sep 18 – Dec 18, 2021 (12 classes) 10:15-11:15am ($218)Rhythmic Gold Stars (2009, 2010, 2011 & 2012): Sep 21 – Dec 14, 2021 (13 classes) 4:10-5:10pm ($236)

Location: Bedford Place Mall (West Halifax Cheer Gym)

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):

Home Phone (optional):

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, Instagram, online ZOOM training and for media release, and on any number of occasions:

Photographic and Digital Images of my daughter YesNo
Video Images of my daughter YesNo

__________________________________________

I have read and agree to the terms presented in the NSRGA INFORMED CONSENT AND ASSUMPTION OF RISK AGREEMENT

Signature (required):

Message / Remarks: