Registration Form

PACC  PORT ARTHUR CURLING CLUB

Junior Curling Program Registration form

2014-2015

PLEASE PRINT

 

Curlers Last Name           First Name                          Birth date (d/m/y)          Gender (F – M)

 

Mailing Address                                                                                                                               Postal Code

Phone#________________________E-mail__________________________________________________

Health Insurance #___________________________________________

List any medical condition the curler has which the instructors should be aware of__________________

 

 

 

Name of Parent(s)guardian:                                                                       Phone #During Curling

I assume all risks incidental to participation in Junior Curling Program and I absolve the organizers and participants from any claims arising out of injury to my daughter/son.

Date________________________Signature of parent/guardian_________________________________

Circle one only                                 Juniors (new)                                    Juniors (returnee)

Is your parent or guardian interested in assisting the Junior Program?     _____    yes _______no

Sticks & Stones Registration Fee of $50.00 including HST -1st session- $25.00 2nd session including HST / Curler to be paid at the PACC Bar.

Junior Registration Fee of $60.00 including HST / Curler to be paid at the Pacc Bar.

Paid_______      _______         Yes ___________________No_______________                  

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