2012 - 2013 GUEST REGISTRATION FORM
PERSONAL
INFORMATION
Student
(guest)Name_________________________________________________________________________________
Student
Date of Birth: ____/_____/______
Parent/Guardian
Ph. Contact # ______________________ other # __________________ other
#___________________
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your email here to be added to our MAILING LIST….
Parent’s
Email address_______________________________________________________
Special
Needs/Allergies:______________________________________________________________________________
Participation Waiver ~
I hereby certify that my
child is in normal health and capable of participating safely in Creative
Movement Center’s programs. I assume all risks and hazards incidental to the
conduct of the program and hereby release CMC or its instructor from any and
all claims for damages and injuries which may be sustained while participating
in any and all activities connected with CMC.
Parent/Guardian
Signature_____________________________________________ Date_________________
