Registration

Gymnast Name *

First

Last

Address Line 1 *

Address Line 2 *

City *

Province *

Postal Code *

Date of Birth (YYYY/MM/DD) *

Age *

Parent/Emergency Contact Name 1 *

Parent/Emergency Contact Name 2 *

Phone Number 1 *

Phone Number 2 *

Phone Number 3 *

Email 1 *

Email 2 *

Has the gymnast previously participated in rhythmic gymnastics? *

Yes No

If "Yes", which level Prism badge did the gymnast receive? *

Please list any previous training (artistic gymnastics, dance, swimming, other) *

Website Permission

I give Norglen permission to use the gymnast's photograph on the club website or any other Norglen promotional material. *

Yes No

Indemnification

I, being the above named gymnast, or the parent or guardian of the above named gymnast hereby consent to the participation in rhythmic gymnastics under the general supervision of the Norglen Rhythmic Gymnastics Club ("the Club"), its coaches and supervisors. I accept complete and total responsibility for myself/my child at all times with respect to my/their participation in the Club program.

In consideration of the Club accepting this application, I, the undersigned, hereby agree to indemnify the Club, its coaches and supervisors, and Rhythmic Gymnastics Alberta from any and all claims or demands which may be made against them in the event that myself/my child is injured while participating in or being transported to or from any location with respect to any event involving rhythmic gymnastics.

I acknowledge that I have read and understood fully the above two paragraphs. *

Yes No