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Tuesday, August 31, 2010 9:18 AM -0400
Learn to dive Registration Form HTML 

Learn to Dive Registration Form

Learn to Dive Registration Form

Diver's Surname:           Diver's Given names:      

 

Age:          Sex:      Date of Birth:      

 

Address (street, city, postal code}:      

 

 Parent's/Guardian's Name:      

 

Home Phone:           Cell/Pager:      

 

Business Phone:           Health Card #:      

 

E-mail Address:      

 

Family Doctor's Name & Phone number:      

 

Medical Concerns (allergies, medication, etc.):         

 

Emergency Contact (name, number and relationship):      

  1. If class numbers are insufficient, you will be given the option of changing classes or refund of fees.
  2. If you wish to cancel your participation, you must do so prior to the first class. A $20.00 cancellation fee will be charged.
  3. In an emergency, if a parent or emergency designate cannot be contacted, permission is given to the Etobicoke Diving Club Inc. to seek medical assistance and treatment as may be deemed necessary.
  4. The Etobicoke Diving Club Inc. will attempt to provide every safeguard to ensure the safety, health and welfare of each participant. The Etobicoke Diving Club Inc., all of its members, directors, coaches, and instructors will be released from any and all losses, damages, expenses, costs, claims, actions, and demands of whatever nature arising from the participation of the persons so named above in any and all programs stated on this form.

Class Dates and Times (please select the class day and time you would like to attend): . . . . . . .

 

 

 
 
Once filled out print form and mail  to :
The Etobicoke Diving Club,
590 Rathburn Rd.
Etobicoke, Ont M9C3T3
 
Or copy completed form and paste into email. Send us e-mail.
 
Or fill out the form, print it and bring to registration