Wee Lads & Lassies 2019

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• Program information on poster below. Please sign up one child per form.

• Registration and payment must be received by Monday, May 6th, 2019 to allow staff to prepare accordingly.

• After submitting registration, parents/guardians will be notified by email about the status of their child’s registration. At this time you will be asked to submit payment. Cash, cheque, or online banking will all be accepted methods of payment (cost is $40 per child).

• If you have any questions, please contact recreation@townofantigonish.ca or 902-867-5596.

Participant's First Name *

Participant's Surname *

Participant's Gender *

Female

Male

Prefer not to disclose

Other:

Participant's Age as of May 11th 2019 *

Required

Please list any special needs requirements, allergies, and medical conditions: *

Parent/Guardian Full Name(s) *

Parent/Guardian Contact Number(s) *

Email Address (this will be used for communication and updates) *

Mailing Address *

Alternate Contact Name *

Alternate Contact Number *

MEDIA RELEASE: During this program, photos/videos may be taken for media or marketing purpose. Please indicate whether or not you grant permission for photos/videos of your child to be taken and used for media/marketing purposes during the program. *

I give permission for my child’s photo/video to be taken and used in media/marketing.

I give permission for my child’s photo/video to be taken and used in media/marketing as long as he/she is not identified.

I do not give permission for my child’s photo/video to be taken and used in media/marketing.

I/we agree not to hold the Town of Antigonish or any of its agents liable for any injuries sustained by any person registered by me/us while he/she is participating in this program. By clicking below I understand I am consenting to the above statement. *

I understand.

I do not understand.

Name of individual who has completed this form: *

Other Notes

Would you like to be on the Town of Antigonish Recreation e-mail list to hear about upcoming recreation opportunities? *

Yes

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