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Seniors at the Barre- 11-1-2024

* marks the required fields

Step #1 - Please Click the Small Box Below and Select Quantity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Step #2 - Please Enter the Requested Information for Each Attendee

Your Information


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Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #2





Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #3





Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #4





Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #5





Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #6





Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #7





Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #8





Enter the name(s) and phone number(s) of your emergency contacts above.

Email List Policy

Each person for whom an email address is provided as part of an event registration is automatically placed on our email list for weekly updates about upcoming activities and other occassional announcements. The recipient of any of these emails may click the unsubscibe link at any point in time to be taken off the list and will not be added again with future registrations.

Waiver of Liability

We require that all participants in Poolesville Seniors activities agree to our Waiver of Liability policy (click here to read it).

We like to keep name(s) and phone number(s) on file for anyone you'd like us to try to contact in the event of an emergency. If you haven't provided emergency contacts for any of the attendees, or just want to update that information, please check below and go back to supply the information with each attendee.

Please type your name as a signature.