ADULT GYMNASTICS REGISTRATION FORM Thursday Jun 5, 2025 to Jun 26, 2025 Classes * Adult Class - THURSDAY 7:30pm - 8:30pm Name * First Last Address: * Phone Number * Email Address * Emergency Contact Name & Phone Number * Doctor's Name and Phone Number * Health Card Information * Medical Concerns Any allergies, medical concerns, that we should be aware of? * — Select — N/A Child 1 - Yes Child 2 - Yes Both Child 1 & 2 - Yes If any please tell me about them here Anything else you would like to tell us ? Informed consent agreement: Print Your Name and the date * I, the undersigned, hereby agree to indemnify and save harmless Willowjays Co. of Sunderland, their/its, instructors, coaches, employees, members against all claims, demands, damages, actions, suits or proceedings arising out of participation of myself/my child, named above, in any gymnastic activity. • I, the undersigned, hereby acknowledge that certain risk of injury are inherent to participation in physical fitness & gymnastics activities. These types of injuries may be minor or serious and may result from one’s own actions, or the actions of others, or combination of both. • I, hereby warrant that my child is physically fit to participate and understand that the choice to participate brings with it the assumption of those risk and results which are part of these activities. • I agree to allow my child to receive basic first aid/medical care from instructors/coaches certified in first aid if necessary. • Willowjays Company reserves the right to use photographs of members for promotional purposes. If you do not wish your child’s photograph to be taken, please notify Willowjays Company in writing. • I declare having read and understand the above informed consent agreement in its entirety and hereby consent to participate acknowledging all the foregoing. I also certify that the information provided in this form is, to my knowledge true and complete. Bill 186, Growing Agritourism Act, 2024: Print your name and date * WARNING: under Ontario law, an agritourism provider is not liable for the death or injury or illness of a participant in an agritourism activity conducted at this agritourism location if that injury or death or illness results from the inherent risks of that agritourism activity. Inherent risks of agritourism activities include, but are not limited to, the risk of injury inherent to land, equipment and animals as well as the potential for you as a participant to act in a negligent manner that may contribute to your injury or death. You are assuming the risk of participating in this agritourism activity. https://www.ola.org/en/legislative-business/bills/parliament-43/session-1/bill-186 PLEASE READ THESE TERMS CAREFULLY * I give consent for my child to be photographed for promotional purposes I do not give permission for my child to be photographed Cash of $120 (bring to 1st class) or send an E-Transfer of $135.60 ($120 + HST) to renee@willowjays.ca (please put your name in the subject line)
