ACR 2013 Spring Newsletter - Municipality of the County of Antigonish

AQUATICS REGISTRATION FORM
PARICIPANT INFORMATION
Parent/Guardian
Mailing Address
Email Address
Home Phone #: Work Phone #:
PAGE 39
MEDICAL INFORMATION
Does your child(ren) have any medical conditions/special needs and/or allergies that our staff should be aware of? If yes,
please indicate what they are
Name of family physician NS Health Card No.
ADDITIONAL CONTACT PERSON
In case of emergency, please indicate another contact person Phone #
PARENT/GUARDIAN SIGNATURE
I/We the undersigned agree not to hold the Municipality of the County of Antigonish or any of its agents liable for any
injuries resulting from or sustained by any person registered by me/us while he/she is participating in the program.
Date Signature of Parent/Guardian
ANTIGONISH COUNTY RECREATION - ACTIVE COMMUNITY RECREATION
Participants Name Age
Date of
Birth
Level
1st Time
Choice
PLEASE MAIL POOL REGISTRATION FORM TO:
ANTIGONISH COUNTY RECREATION
285 BEECH HILL ROAD, RR6
ANTIGONISH, NS B2G 0B4
ATTN: SWIM PROGRAM
2nd Time
Choice
3rd Time
Choice
Swim Registrations will be accepted by MAIL ONLY! Subtotal
Please include payment when mailing registration Discount
Cheques can be made out to "Antigonish County Recreation" Total
YOU CAN FIND MORE INFORMATION ABOUT ANTIGONISH COUNTY RECREATION’S REFUND POLICY AND THE REGISTRATION PROCESS ON PAGE 36
Reg.
Fee