Club Registration | Norwood Community Centre

Playgroup

$40.00

Second half year membership at Norwood Playgroup Wednesday, Feb 5th to June 10, 2020

$35 Playgroup fee + $5 Norwood CC fee

First Name

Last Name

Date of Birth (DD/MM/YYYY)

For Team Sports

While every effort will be made to keep your information private, we cannot guarantee security.

Allergies

Asthma

Carries Epi-pen

Dietary Concerns

Other Medical Conditions

Requires Inhaler

Health Information Details

If you checked any of the boxes above, please provide more detailed information.

First Name

Last Name

Address

City

Canadian Province

Postal Code

Email Address

Phone (Day)

Phone (Evening)

Phone (Cell)

I would like to Coach/Assist/Manage