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Program Registration Form

  1. Please use cheque or money order for mail-in or drop-off registrations. Make cheques payable to the City of Beaumont. Registration and a signed waiver required for all programs.
  2. Where did you hear about the program?
  3. If the course if full, I would like to:
  4. Waiver for Activities
    The following Waiver for Activities must be completed before attending any program.
  5. I give permission for myself/my child(ren) to participate in the above noted program. I understand the nature of the activity, the limited supervision provided and that there are inherent risks associated with this activity and that I or my child(ren) could sustain personal injury through participation in this activity and I am hereby accepting to take that risk on behalf of myself or my child(ren). I hereby agree to save harmless and indemnify the City of Beaumont, its organizers, agents or employees against claims, expenses and demands in respect to injury or death arising out of myself or my child(ren) taking part in this activity but limited to taking part in this activity.
  6. The personal information requested on this form is being collected under the authority of the City of Beaumont Bylaw 382 and Section 33(c) of the Freedom of Information and Protection of Privacy (FOIP) Act. The information collected will be used as for the purpose of setting up utility billing.

    If you have any questions about the collection or use of your personal information, contact the City of Beaumont’s FOIP Coordinator at:
    City of Beaumont's FOIP Coordinator
    5600-49th Street
    Beaumont, AB T4X 1A1
    Phone: 780-929-8782
  7. Leave This Blank:

  8. This field is not part of the form submission.