Name *

First Name

Last Name

Which activity are you registering for? *

Club 57

Avanti!

Date of birth *

MM

DD

YYYY

Name of primary caregiver *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Declaration *

I, the parent/guardian of the registered, give her permission to participate in Rimbrook's activities. I approve of this application and in doing so, agree that the Rimbrook Study Centre staff and volunteers are free and clear of all responsibility whatsoever for any injury or illness that may occur during the applicant's participation in the activity

I give permission for Rimbrook Study Centre fully licenced drivers to drive my daughters to and from activity locations and as the Rimbrook activity requires it

I agree that if in the event of an injury to my daughter, Rimbrook Study Centre staff and voluntary helpers are authorised, by me, to obtain at my expense any medical, ambulance or like services, if deemed necessary or desirable

I give permission for any photos or videos taken during the activities to be used in Rimbrook promotional materials.