Required fields are marked with asterisks (*)

Tennis Lessons - Child & Youth, 11am to 12pm

Pop-Up Program Registration

The Leisure and Community Services department is excited to offer pop-up programs this fall in North Dumfries.

To register for a program, please complete the online form and make your payment via e-transfer. E-transfer payment instructions will be provided after you have submitted your online registration form.

Your program registration will be confirmed by an email from recreation@northdumfries.ca.

Pop-up Program Name, Date and Time

Child's Name:

Child's Age:

Medical Conditions or Allergies: (drug, food, etc.)

Yes

If you answered YES to the question above, please provide the medical conditions or allergies:

Does your child have and Epi-Pen or equivalent product?

Yes

Not applicable

Name of Parent/Guardian #1:

Email Address:

Phone Number:

Mailing Address:

Name of Parent/Guardian #2 (Email Address and Phone Number):

Emergency Contact Name, Email Address and Phone Number

Disclaimer, Waiver: While the Township of North Dumfries supports and encourages physical activities, you should always consult with your doctor before beginning any type of exercise or physical activity. The Township of North Dumfries is not responsible for any damages, loss, injury or death claimed or suffered by any person by any person engaged in any use of the Township facilities unless caused by the sole negligence of the Township of North Dumfries.

By Online or in-person registration I acknowledge that I have read, that I understand and that I agree with this waiver.

Yes

Signature Required

Clear