The Wingham Advance-Times, 1989-06-06, Page 23icb
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WINGHANI RECREATION .406
274 Josephine Street, Box 90
Wingham, Ontario NOG 2V0* 3574208
REGISTRATION FORM .13 oRAMS
Name of Program
Program Session
Program Time
Name of Participant
Date of Birth
Address
Postal Code
Telephone Numbers: Home
Emergency Contact: Name
Special Needs, Prescriptions, Allergies, and/or Medical Conditions
Age Male
Township
Female
Work
Phone Number(s)
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Doctor's Name and Phone
For Daycamp and Swimming Lessons Only:
HIGHEST Level of Swimming Successfully Completed
Date of Completion
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ultimate responsibility or accountability for accidents or careless behaviour of any participants.
NOTE: All reasonable safety precautions will be taken by the Wingham Recreation Department staff to ensure safe programs for you and your children. We cannot, however, accept
In the event of an accident and you or your child requires medical attention, your signature will indicate that the person in charge may obtain the required medical assistanc.e.
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Signature of, Participant/ Parent or Guardian
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