KRSG’s Recreational Registration Form

Recreational Registration Form

To register with the KRSG club please out the form below.

If you have any problems, please e-mail the Program


How do I register my daughter for

the recreational program?


registration is not complete until we receive your cheque to cover

the registration fee.

Spots will be allocated on a first come, first served basis only.


Session Information Please check our schedule for

available class times.



Preferred Day and Time:

Gymnast's Personal Information
Last Name:

First Name:


Name Commonly Used:

(if different from above)

Birth Date:

Street Address:




   Postal Code:

Home Phone: (


Primary Contact
In the event of an emergency, KRSG will

attempt to reach the primary contact first.

Information from KRSG will be sent to the primary contact via email.

Last Name:

First Name:

Day Phone: (


Evening Phone: (


Mobile Phone: (


Email address:

Relationship to Gymnast:

Secondary Contact
Last Name:

First Name:

Day Phone: (


Evening Phone: (


Mobile Phone: (


Email address:

Relationship to Gymnast:

Where did you hear about the Club?

Recommendation from a friend


Community Newspaper


of Paper

Open House

Registration Day at Mall



Medical Information
Are there any medical, family circumstances, or religious requirements

of which the coach should be aware?



If yes, the coach will arrange a private interview.

Parent/Guardian Consent of Participation

and Waiver

By checking the box to the left and submitting this form,

I acknowledge that I am aware that there are risks associated with gymnastics.

I warrant that the participant named on this information form, is physically

fit to participate in gymnastics. I declare that I have accurately disclosed

all information regarding physical, mental or medical conditions affecting

the named participant and acknowledge that this information may be used

for Kanata Rhythmic Sportive Gymnastics (KRSG)/ Gymnastics Ontario’s

(GO) use in the delivery of a gymnastic program. I acknowledge that there

is potential risk for injury involved in training and competing in any

sport. I understand that GO has tried to create a safe and controlled

environment for participation and that KRSG has established rules for

participation on and about the gymnastic area that must be followed by

the participant. I understand that failure to comply with any of the

policies and rules of KRSG and/or GO may result in the suspension or

termination of membership. I waive the rights of the participant to damages

or other costs in the event injury is caused due to participation in

gymnastics or other involvement with the KRSG Club and/or GO.

By checking the box to the left and submitting this form,

I hereby give permission for emergency medical treatment to be administered

to my daughter, as may be determined in the reasonable discretion of

her Personal Coach/Team Manager. It is understood that whenever reasonably

possible, relatives will be contacted and informed of the problem, diagnosis;

treatment required and anticipated medical results.

Photo/Video Release
By submitting this form, I hereby give permission for images of my

child, captured during regular and special KRSG activities through video,

photo and digital camera, to be used for the purpose of KRSG’s

training techniques, website, promotional material and publications and

waive any rights of compensation or ownership thereto.

KRSG Privacy Policy
By submitting this form, I acknowledge that I am aware and agree with

KRSG’s privacy policy as stated below.

Registration Information Privacy Policy: The KRSG Club uses the information

collected at registration for its own purposes associated with the

operation of the club and its registration processes with Gymnastics

Ontario. Information is not released to other third parties for any

reasons without the written permission of the club members.

To facilitate distribution of information within the Club, Club Phone

and e-mail lists are distributed to all members of the Club on a regular

basis. These shall only be used for Club purposes and not distributed

to other third parties

I understand that is my responsibility to ensure that the information

on this form is kept current and I will notify the KRSG of any changes


When the SUBMIT button below is pressed, information entered above

will be submitted to KRSG via standard e-mail over the Internet. If

you prefer, you can print out the form and submit it via regular mail,

sending it to Lynn Chen, KRSG Program Coordinator, 112 Moresby Drive,

Kanata, ON K2M 2J6.


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