REGISTRATION FORM AND AGREEMENT – 2019Registration Form and Agreement • October 30th, 2018
This Agreement consists of four (4) pages, including this Registration Form. Once completed and signed, please return the original to Alecea Snyders / Nicky Brits to secure your child’s enrolment at Aftercare. The original is to be delivered on or before the starting date indicated above. The parent is requested to make a copy of this Agreement.
PLAYER INFORMATIONRegistration Form and Agreement • June 28th, 2021
PLAYER INFORMATIONRegistration Form and Agreement • February 13th, 2020
First Name Last Name Date of Birth USTA Membership Number PARENT/GUARDIAN UTA Profile Number School and Grade Level First Name Last Name Email Address Street Address City State
Winter Season 2019-20Registration Form and Agreement • March 22nd, 2019
Full Season Court Rates Days Time Price Monday-Friday 7AM-8AM $1320 8AM-9AM $1500 9AM-1PM $1795 1PM-3PM $1500 8PM-10PM $2460 10PM-12AM $1350 8PM-11PM $1440 (Friday only) Saturday/Sunday 7AM-8AM $1500 8AM-9AM $1650 9AM-3PM $2460
PLAYER INFORMATIONRegistration Form and Agreement • February 13th, 2020
First Name Last Name Date of Birth USTA Membership Number PARENT/GUARDIAN UTA Profile Number School and Grade Level First Name Last Name Email Address Street Address City State
Upton Earlies and Upton Lates - Registration Form and AgreementRegistration Form and Agreement • June 4th, 2018
Child’s details Name: Class: Date of birth: Home address: Child’s doctor: Telephone:Surgery Address: I consent to my child receiving medical treatment in the event of an emergency YES / NO Parent/Carer details Name: Address: Name: Address: Relationship: Home telephone: Mobile(s):Work telephone(s): Relationship: Home telephone: Mobile(s):Work telephone(s): Person/s authorised to collect children in an emergency Name: Name: Address: Address: Relationship: Relationship: Contact number: Contact number:
PLAYER INFORMATIONRegistration Form and Agreement • December 8th, 2020
Adult Clinics and LessonsRegistration Form and Agreement • February 13th, 2020
Adult Clinics and LessonsRegistration Form and Agreement • September 15th, 2020
PLAYER INFORMATION 0 New Member 0 Existing Member 0 Existing w/changes First Name Last Name Email Address Street Address City State Zip Home Phone Cell Phone Business Phone Emergency Contact Name Relationship to Player Emergency Phone
GOLD STANDARD FACIAL ACUPUNCTURE® Certification ProgramRegistration Form and Agreement • November 13th, 2020
Your credit card is charged when you register for the program and before the beginning of each set of training modules. By signing this agreement, you consent to the fact that your credit card is automatically charged before each set of 2 training modules for the remaining installments even if you withdraw from the program (see cancellation policy).
City Ballet of Cleveland • Registration Form and Agreement 13108 Shaker Square • Shaker Square• Cleveland, Ohio 44120Registration Form and Agreement • August 4th, 2021
PLAYER INFORMATIONRegistration Form and Agreement • September 15th, 2020
PLAYER INFORMATIONRegistration Form and Agreement • March 22nd, 2019
Participation in programs is for the full programs. No refunds will be given for withdrawal r absence after the session begins. Makeups for classes missed are not guaranteed by College Racquet Club.
PLAYER INFORMATIONRegistration Form and Agreement • March 22nd, 2019
Participation in programs is for the full programs. No refunds will be given for withdrawal r absence after the session begins. Makeups for classes missed are not guaranteed by College Racquet Club.
Chambersburg YMCA Charger Swim Team 2023-2024 Registration Form and AgreementRegistration Form and Agreement • August 21st, 2023
Payment plan: Automatic bank/credit card draft: 1st payment due at registration, all other payments will be drafted the first of the month, starting September 25 and ending June 25. Swimmers may opt out of the billing process at any time during the 11-month period if the coach is notified via email by the 15th of the month prior.
Environmental Health Center of Martha’s Vineyard Registration Form and AgreementRegistration Form and Agreement • February 17th, 2019
Acknowledgement and Authority By my signature below, I consent to treatment as necessary or desirable to the patient named above, including but not restricted to whatever drugs, medicines, laboratory, X-ray or other studies that may be used by the attending physician, nurse, or qualified designates. I also acknowledge full responsibility for the payment of such services and agree to pay for them in full at the time of service unless other arrangements are made. I have read and understand the ‘welcome to VPM’ information and I agree to the terms contained here in and office rules to the best of my ability. I have read and understand the financial responsibility form. I also authorize photograph and videotaping of my progress throughout the course of treatment and for my records only.
ContractRegistration Form and Agreement • February 15th, 2019
Please complete all six pages of this registration form and agreement and retain a copy for your records. One form for each individual passenger is necessary. In addition to this completed and signed registration form, please provide a copy of the first page of your passport, which must be valid for at least three months after our scheduled departure to Iceland and contain at least one blank page.
PLAYER INFORMATIONRegistration Form and Agreement • February 13th, 2020
Adult Programs Fall/Winter 2018-2019Registration Form and Agreement • February 27th, 2019
Clinic Starting Date Duration When Fee Beginning/ Advanced Beginner 9/17/18 14 Weeks Tuesday 1;30-1:00 $555$40 Drop In Intermediate 9/17/18 14 Weeks Friday 10:40-12:00 $555$40 Drop In Advanced 9/17/18 14 Weeks Tuesday 11;30-1:00 $555$40 Drop In Drill Special 9/17/18 14 Weeks Tu or Fri 8:00-9:00 $365$27 Drop In
REGISTRATION FORM and AGREEMENTRegistration Form and Agreement • April 1st, 2019
Clinic Starting Date Duration When Fee Beginning/ Advanced Beginner 9/17/19 14 Weeks Tuesday 1;30-1:00 $555$40 Drop In Intermediate 9/20/19 14 Weeks Friday 10:40-12:00 $555$40 Drop In Advanced 9/17/19 14 Weeks Tuesday 11;30-1:00 $555$40 Drop In Drill Special 9/17/19 14 Weeks Tu or Fri 8:00-9:00 $365$27 Drop In
PLAYER INFORMATIONRegistration Form and Agreement • February 13th, 2020
First Name Last Name Date of Birth USTA Membership Number PARENT/GUARDIAN UTA Profile Number School and Grade Level First Name Last Name Email Address Street Address City State
