Kids Yoga Adventure Club Registration

Please note that completing a form does not guarantee registration. Staff will contact you to confirm your spot in this program.

Fields marked with * are mandatory.

Participant 1 information

Participant 1 Name * First and last name

Participant 1 Date of Birth *

Participant 1 Age *

Do you have a second participant to register? *

Yes
No

Participant 2 information

Participant 2 Name * First and last name

Participant 2 Date of Birth *

Participant 2 Age *

Do you have a third participant to register? *

Yes
No

Participant 3 information

Participant 3 Name * First and last name

Participant 3 Date of Birth *

Participant 3 Age *

Parent/Guardian Information

Parent/Guardian name * First and last name

Parent/Guardian Telephone Number *

Parent/Guardian Email Address *

Additional Parent/Guardian name First and last name

Additional Parent/Guardian Telephone Number

Additional Parent/Guardian Email Address

Emergency Contact Information

Emergency Contact Name * First and last name

Emergency Contact Telephone Number *

Emergency Contact relationship to participant(s)

Consent

Photo release

During our activities, there may be times when photographs may be taken of the participants. These photos may be used for publicity purposes or may appear in local media.

By selecting yes, you hereby authorize the City of North Bay to publish photographs taken of persons under your legal guardianship for use in print, online, and municipal publications. You acknowledge that their participation is voluntary and that neither you nor the participants will receive any financial compensation for the use of these photographs. You further agree that your wards' participation in any publication, photo, or website confers upon you or your wards no rights to ownership of the original photo or the forum in which it was used. You hereby release the City of North Bay from any liability or third-party claims regarding the use of these photographs.

May the City of North Bay use photos of your child(ren) for publicity purposes? As outlined above.

Yes
No

Consent for collection, use and storing data * I acknowledge that my information will be collected, used and stored by the City

Yes, I give permission to collect, store and process my data.

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act and will be used for its intended purpose only. Questions about this collection or personal information should be directed to the City Clerk, 200 McIntyre Street East, North Bay ON P1B 8V6, or by telephone at (705) 474-0626 ext. 2510.