Windsor Aquatic Club - Permission Form
Meet:
2007 Western Ontario Regional Championships
Hosted By:
Location:
Date:
Session Times:
Cost:
per event
x _ _ _ _ _ events
=
Team Surcharge
Total
$ _ _ _ _ _ _
Windsor Aquatic Club - Permission Form
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Meet: |
2007 Western Ontario Regional Championships |
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Hosted By: |
Brantford Aquatic Club www.csca.org/brant | |||
Location: |
Brantford, Ontario | |||
Date: |
February 2-4, 2007 | |||
Session Times: |
See; www.csca.org/brant "Meet Results" | |||
Cost: |
$6.50 | per event |
x _ _ _ _ _ events
= |
$ _ _ _ _ _ _ |
Team Surcharge |
$200.00 _ | |||
Total |
$ _ _ _ _ _ _ |
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Return completed permission form to COACH with payment attached |
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NO LATER THAN - |
January 20,2007
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- NO EXCEPTIONS |
Name: |
_______________________________________________ |
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Western
Ontario Regional Championships - Brantford, Ontario
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Payment enclosed: |
$____________________ | |
| I am a parent (guardian) of the above child, and in consideration of the Windsor Aquatic Club permitting my child to take part in the aforementioned swim meet, I hereby agree that the Windsor Aquatic Club, its officers, directors, coaches and members shall not, except for negligence, be responsible for any injury, loss, damages or costs which may be suffered or incurred by me or my said child arising out of the said meet, including, but not limited to transportation to and from the meet, accommodation at the meet, and incidental activities while attending the meet. PARTIAL REFUNDS ON TRAVEL AND ACCOMMODATION FEES FOR MEDICAL REASONS ONLY. | ||
| SIGNATURE:___________________________________ DATE:______________ |
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