Sole Boys
Home
Team
Jobs
Coach
Register
Volunteer "Man-tor"
Parent Ambassadors
Empowered Sole Summer Camp!!
Registration Form
Simply fill in the form below to secure your
spot
.
*
Indicates required field
Which 2 day Summer Camp? (choose none if 5 day camp)
*
Williams Lake July 6/7 (7-9years)
South Surrey July 6/7 (Ages 7-9) at 23/7
South Surrey July 9/10 (Ages 10-13)
Kamloops (Ages 8-12) July 9/10 TRU
Vancouver July 13/14 (8-12years) Lululemon
North Van (Ages 8-12) Aug 17/18th MEC
North Van (Ages 11-14) Aug 20/21st MEC
none
Which 5 day Summer Camp? (choose "none" if 2 day camp)
*
Calgary July 13-17th 2015
North Vancouver August 10-14th
North Vancouver August 24-28th
none
What school does the participant attend?
*
Participant's name
*
First
Last
Participant's date of birth
*
What grade is the participant in?
*
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Parent/Guardian's name
*
First
Last
Parent/Guardian's email address
*
Parent/Guardian's contact number
*
Parent/Guardian's Address
*
Line 1
Line 2
City
State
Zip Code
Country
Name of emergency contact
*
First
Last
Emergency contact's phone number
*
Relationship to participant
*
Medical information, please check if the participant has a history of any of the following: (Please check all that apply)
*
Heart Disease or heart Problems
Hypertension or High Blood Pressure
Stroke
Diabetes or Abnormal Blood Sugar Test
Epilepsy or Seizures
Abnormal Chest X-ray
Orthopaedic or Muscular Problems
Participant lives with someone who smokes
Participant has a close relative (Mother, Father, Sibling) with a history of Heart Disease
Asthma or Allergies? (If yes, please tell us more below)
Participant uses inhaler
Participant uses an epipen
No history of medical problems
Other (please indicate below)
Any other health issues or prescription drugs?
(if yes, please describe)
*
Please check the following to confirm you agree.
Purpose of the program: The purpose of the program is to empower your daughter with self- confidence, increase your daughter’s activity/fitness level and self-esteem while at the same time teaching life skills that will be beneficial to her as she enters adolescence.
*
Yes
Release (Injuries): Serious health risks are rare. Physical reactions to exercise may include heat related illnesses, abnormal heartbeats and blood pressure and in rare instances heart attacks. While we take all reasonable precautions, we can make no guarantees regarding these risks. You (the parent or legal guardian) agree not to hold Ashley Wiles, the coach, or Sole Girls liable for any injury or damages due to participation in the Sole Girls program.
*
Yes
Release (Photo): During the program, we occasionally take photos and videos of the girls for use in our future programs and to recap the event for the girls at the end of the program. With your permission given herein, we may also use these photos and videos for future brochures, publications, or in other ways to promote the program.
*
Yes
Authorization: I,the parent/guardian, have read this form and I am aware that by typing my name below it I am waiving certain legal rights. I understand there are inherent risks associated with physical activity. To the best of my knowledge there are no contradictions to my daughter’s participation in the Sole Girls program. By my signature below, I give permission for my daughter to participate in this program, including any pictures or videos in while she appears to be used as described above and for the information specified above. Cancelation Policy: 2 weeks prior to the beginning of the course 10% fee is charged. Less than 2 weeks prior to the course a 20% fee is charged. No refund will be issued once the course has begun.
*
Yes
I'd like to receive email updates, information and promotions from Sole Girls!
*
Yes
No
I, AGREE TO THE ABOVE TERMS BY TYPING MY NAME BELOW
*
First
Last
Signed, Today's Date
*
Submit
Home
Team
Jobs
Coach
Register
Volunteer "Man-tor"
Parent Ambassadors