J4K Free Session-Peterborough & Central Ontario Register Here for the Just4Keepers Academy J4K Peterborough Free Session If you are a human and are seeing this field, please leave it blank. Fields marked with a * are required J4K Peterborough Free Training Session Free Training Session In Your Area Choose A Day/Date * Please Note: Your J4K coach will confirm date and times. Upon Completion of this form you will be forwarded a Confirmation email. Gender * Female Male Your Age Group * -Select- U10-U13 U14up Phone * Cell Phone Find Out About Just4Keepers Peterborough * Referred by a fellow keeper (Please name below) Internet Flyer Other (Please Specify Below) Parent/Guardian Consent I hereby consent to any and all health services necessary by Just 4 Keepers staff to refer my child for consultation to any licensed medical specialist or to any area Emergency Room. I give authority and power to any such physician/surgeon to render any and all health services that may be deemed necessary or advisable. I authorize the Just 4 Keepers Director to accompany my child and sign permit forms required by the Medical Counter. I understand in case of serious accident or illness every effort will be made to contact me. I understand I will be responsible for any costs or care provided. Covid 19 I acknowledge the contagious nature of the Corona virus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing, further acknowledge that Just4Keepers Peterborough has put in place preventative measures to reduce the spread of the Corona virus/COVID-19. I further acknowledge that Just4Keepers Peterborough can not guarantee that I will not become infected with the Corona virus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Corona virus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, J4K Peterborough staff, and other J4K clients and their families voluntarily seek services provided by Just4Keepers Peterborough and acknowledge that I may be increasing my risk to exposure to the Corona virus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my training sessions. Do You Consent * Yes No Comments or Questions What does 2+8= * PLEASE NOTE: Upon Completion of this form you will be forwarded a Confirmation email. ￩ ￫ x ×
