EmailMe Form - After School Prg.

PARENTS INFORMATION

Mothers Name *

Fathers Name

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Cell Phone Number #1 *

### - ### - ####

Cell Phone Number #2

### - ### - ####

Email #1 *

Email #2

CHILD #1 INFORMATION - After School Program (ASP)

ASP#1: Child's Full Name *

Date of Birth *

School Name *

Teachers Name *

Grade *

Shirt Size *

Child #1: Sports *

After Training *

Child#1: Parent Pick up

Child#1: After Care

Child #1: Bus

Child #1: N/A

Aftercare and/or Bus Name

Would you like to register another child? *

Registration for second child

No, only registering one child

If you are only registering one child, please proceed to our insurance information field below

CHILD #2 INFORMATION

ASP#2: Child's Full Name

Date of Birth

School Name

Grade

Teachers Name

Shirt Size

Child #2: Sports

Second Child's After Training

Child #2: Parent Pick up

Child #2: After Care

Child #2: Bus

N/A

Aftercare and/or Bus Name

Would you like to register another child?

Registration for third child

No, only registering two child

If you are only registering two children, please proceed to our insurance information field below

CHILD #3 INFORMATION

ASP#3: Child's Full Name

Date of Birth

School Name

Grade

Teachers Name

Shirt Size

Child #3: Sports

Third Child's After Training

Child #3: Parent Pick up

Child #3: After Care

Child #3: Bus

N/A

Aftercare and/or Bus Name

INSURANCE INFORMATION

Do you need ALM Sports Insurance?
ALM Insurance cost $10 to cover the total program (training sessions + games) *

Yes, ALM Sports Insurance

No

Do you need Insurance for your Second Child?

Yes, second child insurance

No

Do you need Insurance for your third child?

Yes, third child insurance

No

Primary Insurance Details
(your childs insurance carrier and policy number)

Medical Concerns

MEMBERSHIP PROGRAM (Sept 2014 - Aug 2015)

Applicable for all programs: Holiday Camps, Merchandise, After School Programs & More

Would you like to enroll your first child in our membership program

Yes, membership for child

My child is already enrolled (via membership page)

No, not at this time

Annual $50 fee. If you are unsure of membership details please visit our program page or contact us for more info

Would you like to enroll your second child in our membership program

Yes, second child membership

My child is already enrolled (via membership page)

No, not at this time

Would you like to enroll your third child in our membership program

Yes, third child membership

My child is already enrolled (via membership page)

No, not at this time

TERMS & CONDITIONS

I have read and agree to the Terms of Service *

Yes, I agree.

If your child is covered by a private insurance, you must provide us with proof of your child’s insurance coverage. If your child is not, We offer this through WestPoint Insurers at a cost of $10.00 for the entire program. Please note; your Insurance fees covers both training & game days. I give consent for my child to take part in the activity and consent to emergency treatment as necessary. I accept that the organizers and their employees are not under any liability whatsoever in respect of injury, loss or damage whilst on the course, other than imposed by law. I also allow ALM Sports to take photos for advertising and promoting purposes only; if you do not want your childs photo to be taken please email admin@almsports.com. I confirm that my personal insurance is correct and bears responsibility in case of accidents. I confirm that I am legally entitled to give this consent and understand all payments received are non-refundable.