Sole Boys
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Soleteer Registration Form
Please fill in the form below to secure your
spot
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Indicates required field
Which program are you interested in Volunteering for?
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Eastside Fitness East Van Mondays
Kits Tuesdays
MEC North Van Thursdays
Mulgrave School Fridays
Coquitlam Saturdays
South Surrey Saturdays
Summer Camp Nvan
Summer Camp Van
Summer Camp South Surrey
Where do you study?
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Participant's name
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First
Last
Participant's date of birth
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Address
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Line 1
Line 2
City
State
Zip Code
Country
Name of emergency contact
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First
Last
Emergency contact's phone number
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Relationship to participant
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Medical information, please check if the participant has a history of any of the following: (Please check all that apply)
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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)
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Please check the following to confirm you agree.
Purpose of the program: The purpose of the program is to empower you with self- confidence to lead groups of adolescents and create meaningful conversations, increase your leadership skills and awareness and self-esteem while at the same time teaching life skills that will help you achieve your goals
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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 or Sole Girls liable for any injury or damages due to participation and volunteering in the Sole Girls program.
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Yes
Release (Photo): During the program, we occasionally take photos and videos 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.
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Yes
Authorization: I, have read this form and I am aware that by signing 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 participation in Sole Girls. By my signature below, I agree to participate in this program, including the evaluation testing, for any pictures or videos in while I appear to be used as described above and for the information specified above.
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Yes
I, AGREE TO THE ABOVE TERMS BY TYPING MY NAME BELOW
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First
Last
Signed, Today's Date
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Volunteer "Man-tor"
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