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Cardio and Strength Conditioning Registration Form
Cardio and Strength Conditioning Registration Form- Fall 2023
Cardio and Strength Conditioning Registration Form- Fall 2023
Class Details
Fitness Class – Cardio and Strength Conditioning Class Times: Monday's 6:30 pm to 7:30 pm Class dates are Sept 18, Sept 25, Oct 2, Oct 16, Oct 23 & Oct 30th. Cash, Debit, Cheque (Town of Pilot Butte), E-Transfer (pbetransfer@sasktel.net, include your Name and Program Name) or OptionPay (Third Party Credit Card payment system, additional fees apply)
Name
*
First
Last
Parent/Guardian Name if the participant is under the age of 18
First
Last
Address
*
Street Address
PO Box #
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Phone
*
The best number to get a hold of you at in case of cancellations.
Email
*
Age
*
Any relevant medical information or allergies?
Program Fees
Price:
$ 50.00 CAD
This is a 6 week program and the fees include GST.
Payment Options
*
Cash
Debit
Cheque (Town of Pilot Butte)
E-transfer (pbetransfer@sasktel.net)
OptionPay (Third Party Credit Card System, additional fees apply)
Please indicate which payment method you plan on using. E-transfers can be sent to pbetransfer@sasktel.net. Be sure to include your name and program name in the message section.
Refunds and Special Notes
Should the Town of Pilot Butte cancel a program due to insufficient enrollment, a full refund will be provided. A refund request that is received seven (7) days prior to the start of a course will receive a 100% refund. A 50% refund is issued if cancellation is received less than 7 days prior to course start or if the program has started but is less than 20% complete. A prorated refund will be issued for cancellations at any time due to medical reasons (medical certificate required). Please allow 4-6 weeks for processing and mailing of a refund cheque.
Consent
*
Waiver of Liability
I agree to release, indemnify and save harmless the Town of Pilot Butte, and its elected officials, officers, employees, agents, representatives, volunteers and other participants from and against all claims, proceedings and/or actions in respect of any costs, losses, damage or injury arising by reason of my or the dependent registrants’ participation in any activities offered by the Town of Pilot Butte, or by reason of the provision of medical care by the Town to me or the dependent registrants.
I have read and understood the Waiver of Liability.
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