Cooking Class Registration Form

Required fields are marked with asterisks (*)

Program Registration Form

Make and Take Cooking Class

First Name

Last Name:

Birth Date

Address:

Postal Code

Phone:

Email:

Medical Information - Food Allergies

Program

Fee:

Terms and Conditions

Payment and Submission

Payment and submission of this form does not guarantee registration into the selected course. If the course is full or not available, the funds will be returned. Payment can be made by cheque or cash. If paying by cheque, please make cheque payable to Township of Alnwick Haldimand and either mail to 10836 County Rd. 2 Grafton, ON. or drop in mail slot at the same address.

Collection of personal information

Personal information on this form is collected in accordance with the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990 c.M. 56 under the authority of the Municipal Act 2001, S.O. 2001, c25 and will be used by the Township of Alnwick/Haldimand for the operation of recreation programs.

Waiver of Liability

I agree to release and save harmless the Township of Alnwick/Haldimand, and its employees and other agents from any and all claims or other proceedings, regardless of who makes them, in respect of any damage or injury arising by reason of participation in the course by myself or the person(s) who are shown as registrant(s).

Signature:

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Date:

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