Junior Membership

Registration Agreement

Name                                                                                                                     Age of Junior                                         

Address                                                                                                                Purchase Date                                         

                            Street

                                                                                                                          Account ID                                         

                            City, Province

                                                                                                                           Parent/Guardian                           

                            Postal Code                                                                                   

                                                                                                                                                                                                                  _________________

Telephone                                                                                               

                            (day)

                            (evening)

Email                                                                                                      

                            We respect your privacy.  No information you provide will be shared or sold

                                                                                                                              Date                                                       

Signature of Junior Member

                                                                                                                              Date                                                       

Signature of Legal Parent or Guardian

                                                                                                                              Date                                                       

Signature of Oakridge Head Professional