EmailMe Form - Child Registration

Child Registration

Register by completing the following online registration.

Payment is available by:
- Etransfer to pwretf@mymts.net,- Use password pwrd21
- Cheque payable to Prairie West Recreation
- Cash
Our local office is located:
- Virden at the C.P.R. Historic Centre 425 6th Avenue South (Dropbox available 24/7)

Mail Chq to : Prairie West Recreation Box 2006 Virden MB R0M 2C0

Registrations are on a first come, first serve basis.
Full payment is required to confirm your registration.
There will be a $10.00 late fee implemented for registrations received after stated registration deadline.

As of April 1st 2015 if you do not live in the Town of Virden or RM of Wallace-Woodworth (Including the Village of Elkhorn) there will be an additional $5.00 "out of district" user fee per person per program.

Contact the PWR office at 204-748-2542, email us at pwr@mymts.net, or visit our website at www.prairiewestrecreation.com

Child's Name *
First Last
Program registering for: *
Age *
Medical Conditions
Date of Birth *
MM / DD / YYYY
Parent/Guardian Name
First Last
Email *
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Daytime Phone Number *
### - ### - ####
Emergency Contact *
First Last
Emergency Contact Phone Number *
### - ### - ####
Photo Release
Yes
No
I give permission to have my child's picture taken while at the PWR program. I understand these pictures may be published in the newspaper, or on Facebook.
Would you like to receive Prairie West Recreation's free ENEWS?
Liability Waiver
I certify that I am in good health and able to participate in vigorous activities involved with Prairie West Recreation District programs. I authorize the directors and instructors to seek emergency medical treatment if it is deemed necessary. This also assures that I release the instructs, Prairie West Recreation Commission and the program facility from any liability from any injury or illness incurred going to the program from home, while at the program, or returning home from the program. I agree to hold harmless the instructors, Prairie West Recreation Commission and the program facility and its operators of all liabilities for losses and damages of all and every description.
Payment Method *
Office Use Only
Receipt Number & Amount Paid
Dropdown