Fall 2017 Mini-Teens Registration Registration may be made at the Chantal Berube Youth Centre (5202 50 Street), in person
Tuesday-Thursday 3:30pm-8:00pm, or Friday-Saturday 5pm-10pm. Completed forms may also be emailed to adrienne.king@beaumont.ab.ca. Drop-in registrations WIL NOT BE ACCEPTED Registration deadline is the Tuesday BEFORE the Mini-Teens date. Mini-Teens will be cancelled if registration is under 15 participants. You will be notified via email the Wednesday before the Mini-Teens date. Lunch will be provided and the cost of Mini-Teens is $5.00. Payment accepted day-of, at the door. Maximum 30 participants.
Name of Participant:___________________________ Additional Information: (please be as specific as possible) Name of Parent/Guardian:______________________ Allergies:_____________________________________ Birth Date of Participant:__________________________ Any medical considerations? (must be between the ages of 6-11 to participate) ____________________________________________ Email Address:
____________________________________________
________________________________________________ Telephone number: ___________________________
Emergency Contact Name/#: ____________________ (if parent/guardian is unreachable)
Please indicate which day(s) you are registering for
Mini Teens Registration Dates Saturday, September 23, 2017
1-4pm
Saturday, October 21, 2017
1-4pm
Saturday, November 18, 2017
1-4pm
Cost ($5/Mini-Teens event) Includes lunch
Town of Beaumont Waiver for Activities This Waiver for Activities form must be completed before attending any programs. Please read carefully. I give my permission for my child ( ren ) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ to participate in _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ on ( date) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . I understand the nature of the activity, the limited supervision provided and that there are inherent risks associated with this activity and that my child ( r en ) could sustain personal injury through participation in this activity and I am hereby accepting to take that risk on behalf of my child ( ren ) . I hereby agree to save harmless and indemnify the Town of Beaumont, it ’ s organizers, agents or employees against claims, expenses and demands in respect to injury or death arising out of myself or my child ( ren ) taking part in this activity, but limited to taking part in this activity. _ _ _ _ _ _ _ _ _ _ _ ______ _ _ _ _ _ _ _ _ _ Signature of Participants Parent/Guardian
_ _ _ _ _ _ _ _ _ _____ _ _ _ _ _ _ _ _ _ _ _ _ _ Witness
_ _ ___________ _ _ _ _ Date
For more information contact the Chantal Berube Youth Centre at (780)929-5155. Information and Registration Forms are available at the Chantal Berube Youth Centre or online at www.beaumont.ab.ca/220/CBYC Please note: The personal information contained on this form is being collected under the authority of the Municipal Government and FOIP Acts, and will be used as required by Town staff for registering in and promoting of recreation programs, accounting purposes, medical and emergency information. The collection of this information is protected by the privacy provisions of the FOIP Act. Photographs may be used for advertising purposes. If you have any questions or concerns, please contact the FOIP coordinator at the Town of Beaumont (780) 929-8782