Registration Form
(Complete a separate form for each location)
Registrant One: Male  Female
Last name
First Name
Phone:
Course:  
Location:
Date of 1st Class:
Fee:
Material Fee:
(unless payable to instructor)
Registrant One: Male  Female
Last name
First Name
Phone:
Course:  
Location:
Date of 1st Class:
Fee:
Material Fee:
(unless payable to instructor)

PAYEE INFORMATION

Last Name:    First Name:    Phone:   
Address:   
   (Street, P.O. Box # or Rural Route)

(Town)

(Postal Code)
E-mail address:    I will accept e-mail notices: Yes or No 
 Visa: MasterCard:
Card #  Expiry
The registrant, as an enrollee in the course/activity designated above, recognizes that there are inherent risks in any activity and significant risks of injury in sports and shop activities. The registrant agrees to assume all risks incident to participation in said class/activity and shall fully indemnify and hold harmless the Bluewater District School Board from and against all losses, costs, charges, damages, expenses, awards, liens, claims and demands whatsoever which the Bluewater District School Board may be subject to as a result of this participation in said class/activity.
Registrant One: I agree Registrant Two: I agree

Please identify this colour: