DELCO TRAINING CENTER REGISTRATION FORM
Name: Date of Birth: Age:
Street Address: E-Mail:
Town: State: Zip Code:
Home Phone: Business Phone: Cell Phone:
Parents or Guardians:
Friend or Relative to be notified if parent cannot be reached:
Name: Relationship: Phone:
Class Selection:
Day: Time: Amount Enclosed:
PARENTAL RELEASE: I hereby release Delco Training Center, Inc., the owners and instructors from all damage claims that could occur during these sessions. I understand that all fees and deposits are nonrefundable or transferable.
Parent's Signature: Date:
Mail this registration form with your check to: DELCO TRAINING CENTER, 1801 Bullens Lane, Woodlyn, PA 19094
Height: Allergies: PAYMENT RECORD
Weight: Current Medications: QUARTERS DATE CK-REC# AMOUNT
Preferred Physician:
Operations or Serious Illness: 1st
Phone #
RELEASE -I herby consent to have my child/ward participate in programs offered 2nd
by the Delco Training Center. It is hereby agreed that I, my child(ren)
adoped or otherwise, my seecutors or heirs, waive and release all
rights and claims for damages that I may have at any time. The risks 3rd
in respect to such a program are fully understood. This release is valid
and any all sessions. PERMISSION FOR MEDICAL TREATMENT:
I confirm that the above named person is in good health. I hereby
authorize and consent to simple first aid, x-ray exams, anesthetic,
medical or surgical diagnosis or treatment and hospital care.
**Office use Only**
SIGNATURE (PARENT/GUARDIAN) DATE: