North Bay Legion Track Club Registration Form
Child and Parent/Guardian Information |
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Child’s Name
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Date of Birth (dd/mm/yyyy)
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Last School Attended |
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Address
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Parent/Guardian Name |
Parent/Guardian Name
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Phone Number(s)
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Phone Number(s) |
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Email Address
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Email Address |
Alternative Emergency Contacts |
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Primary Contact
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Secondary Contact |
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Phone Number(s)
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Phone Number(s) |
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Address
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Address |
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Relation to Child |
Relation to Child
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Medical Information |
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Allergies/Specific Health Concerns
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Physician’s Name |
Physician’s Phone Number
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Ontario Health Card Number
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Other Important Information
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Registration/Payment Details |
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o Week 1 (July 4 – 8) o Week 2 (July 11 – 15) o Week 3 (July 18 – 22) o Week 4 (July 25 – 29) |
Siblings Registered (yes/no) Name:
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Payment Method (filled out at Club)
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o Cash |
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o Cheque |
Name on Cheque:
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Total Amount |
Date Received:
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