Participant Name *

First Name

Last Name

Parent/Guardian or Legal Representative's Name *

(If you are your own guardian, please enter "not applicable" in both fields)

First Name

Last Name

Phone - Primary *

(###)

###

####

Phone - Secondary

(optional)

(###)

###

####

Participant Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you want to be contacted when the next registration is open?

Yes

No

How did you hear about The Good & Strong Club?

Check as many as apply

Facebook

Instagram

E-Newsletter

Word of Mouth (from a friend, relative, etc)

Another Community Organization (The Arch, The Living and Learning Center, etc)

Other

Emergency Contact Name *

First Name

Last Name

Phone

(###)

###

####

You will need to sign a Waiver of Liability form before participation in The Good & Strong Club. How would you like to complete this form? *

I, or my parent/guardian/legal representative, will complete this form in person. I will arrive 5-10 minutes early to complete this form.

I would like this form to be emailed to me, or my parent/guardian/legal representative. I will either utilize an electronic signature, or print and sign the document. I will return the document either by scan and email, or by sending it with the participant to the meeting. (By utilizing an electronic signature, I consent to its use for the purpose of completing this waiver.)

I already have a signed Waiver of Liability on file from participation in another Good & Strong Club event.