Junior ButterFlys Registration Form
Items marked with
*
are required.
*
First Name
*
Last Name
*
Parent Name
Address 1
Address 2
City
State
Zip:
*
Telephone Number
*
Age
Select Age:
6
7
8
9
10
11
12
13
14
15
16
Email Address
Skating Level
Beginner
Intermediate
Advance
Medical Restrictions
How did you hear about the
Jr. ButterFlys'?
*
In case of an emergency, if I can not be contacted, I give permission for my child to receive medical treatment. I waive and release The Butterflys N Unity, its officers, members, and staff from all liability for any injuries or illnesses incurred during the Summer Program
.
Select One
Yes
No
*
I agree to permit The Butterflys N Unity to photograph my child for the sole purpose of their website/marketing.
Select One
Yes
No
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