Into the Elements Registration Form

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Into the Elements Registration Form - SNOWSHOE EXCURSION

Program: SNOWSHOE EXCURSION
Instructor: Jennifer Beaumont-Becker
Host: Jennifer Beaumont-Becker with Volunteers
Date: SATURDAY, JANUARY 22, 2022
Ages: *Grades 1-3 Timeslot 1 OR *Grades 4-7 Timeslot 2
Timeslot : *1:00-2:30pm OR *2:45-4:15pm
Dropoff: CENTENNIAL STATION GAZEBO, At Main Street & Railway Street
Check-in: At Gazebo, no sooner than 5 minutes before
Pickup: HERITAGE COMMON, At 703-2nd Street East, Town's newest facility
Fees: $10/participant. E-transfer to recreation@hepburn.ca
Bring: Warm footwear, extra warm clothes, small backpack, sturdy water bottle, & own snack
Provided: Snowshoes, Hot chocolate/warm drink at the end.

*NOTE: Use washroom before coming, as they are only available at the end of the excursion at the Heritage Common. Other program details are available on the website at www.hepburn.ca under Recreation.

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E-post *

Timeslot *

Timeslot 1 - 1:00-2:30pm for Grades 1-3

Timeslot 2 - 2:45-4:15pm for Grades 4-7

Participant Name *

Current Age / Current Grade *

Parent / Guardian Name *

Phone Number *

Health Conditions / Allergies / Accommodations, if any, OR write None. *

Media Release Section - We request consent in allowing the publishing photographs involving your child. Please select your choice below. *

Yes, I allow the reproduction and publication of my child's photograph, OR

No, I do not allow.

Media Release Section - We request consent in allowing the publishing of your child's name. Please select your choices below. *

Yes, I allow the publication of my child's NAME, or

No, I do not allow.

Parent Waiver Section - I acknowledge that my child/children are participating voluntarily in the events and activities outlined above. In consideration of that participation, the child and parent/guardian agrees to waive all claims and release from liability and not to sue members of the Hepburn Parks and Recreation Board or Program Leaders, for any injury, death, or property damage or other loss or complaint sustained in participation in the event. *Post Parent Initials and Date in space below: * *

Payment - I have sent an e-transfer to recreation@hepburn.ca. Note: there is no password required. *

Yes

Comments or Questions: If you have questions, please note below.

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