REGISTRATIONS CLOSED FOR AN Myer Girls Basketball Clinic Registration November 8, 2024 Parent Name* First Last Email* Phone Number*Child's Name* First Last Child's age*Does your child have any allergies? If so, please describeIs there anything else you would like us to know about your child?Where did you hear about us?* Social Media Friend or family member Search Engine (Google, Yahoo, etc.) Little Medical School Website How would you like to pay?* PayPal e-Transfer 2024 AN Myer Girls Basketball Clinic - November 8, 2024Join us for this exciting Basketball clinic to support sport, education and health in our community. Whether you're a beginner or an experienced player, this clinic will help you sharpen your skills by training with the talented players of the AN Myer Girls Basketball Team and get expert advice on how to avoid and treat common sports injuries from an instructor of the Little Medical School. Let's work together to make a difference through sports and education. See you on Court!! Proceeds go towards supporting the AN Myer Girls Basketball players and program.AN Myer Girls Basketball Clinic and Sport Injury Workshop....$60.00 Clinic and Workshop 5:30-8:30pm at AN Myer SS Gym Niagara Falls, Ontario AN Myer Girls Basketball Clinic and Sport Injury Workshop....$60.00 Price: Light snacks will be providedI give consent to have photographs and/or video taken of my child during class/camp sessions* Yes NO Waiver Form* I have read and agree to the Parental waiver below for my child. This agreement releases Little Medical School Niagara/Ontario, it's employees and/or independent contractors from all liability relating to any injuries, physical or otherwise, loss or damage to person or property that may occur to my child/children, however caused, arising out of or in connection with their taking part in any of the Little Medical School classes, instructions, camps, birthday parties or any programs offered. I also acknowledge the risks there may be with the use of medical instruments as part of the instruction, and that my child may bring home. These include but are not limited to stethoscopes, BP cuffs and reflex hammers. Additionally, my child does not have any conditions that will increase their likelihood of experiencing injuries while engaging in the activities. By consenting to this agreement, I agree to hold Little Medical School Niagara and Little Medical School Ontario, entirely free from any liability for any reason, and that all risks are clear to me.Total $ 0.00 CAD Please make payment via INTERAC e-Transfer to: niagara@littlemedicalschool.com Input your e-transfer confirmation number in the box below. Click submit to finalize the registration. Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name e-Transfer Confirmation* Please note: Your registration is complete only upon receipt of payment. Class Cancellation Disclaimer Please note that all classes are subject to a minimum enrollment requirement. If we do not receive enough student registrations, the class will not be held. We will notify you in advance and provide full refunds if a class is canceled due to insufficient enrollment. Thank you for your understanding.Credit Card* American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name CAPTCHA Δ
