Community Programs | Community Center

Programs Order Form

First name

Last name

Phone

For safety purposes please list any health problems, disabilities, allergies etc.

I understand that participation in Community Association programs involves risks, including possible injury. I voluntarily accept these risks and acknowledge that my participation in activities and use of facilities is at my own risk.

In registering for this program, I waive and release the City of Prince George, School District #57, and their representatives from any liability for injury, illness, loss, or damage that may occur during participation, including claims to negligence.

Provide your Emergency Contact Name and Phone Number:

Parent/Guardian Consent (Under 18) I am the parent/guardian of the participant and give permission for them to participate in Blackburn Hall programs. Provide the Parent/Guardian Name and authorization to allow the participant to attend.

Programs

Floor Hockey - Wednesdays April 8-June 10 BB Elementary Gym 7:00-8:00pm$50

Pilates (ages 18+)Mondays April 13-June 15 (no class May 18) BB Elementary Gym$60

Zumba (ages 15+)- Tuesdays April 14-June 16 Blackburn Elementary Gym 6:30–7:30 $80

Core Boot Camp with Myeracle - Tuesdays April 21-June 23 Blackburn Hall$80

Volleyball (ages 16+) - Wednesdays April 8- June 10 BB Elementary Gym$50

Seniors In Motion (ages 50+) - Thursdays April 9-June 11 Blackburn Hall$20

In signing this form, I agree to allow all the information contained within, to be accessed by program leaders and the Community Association administration personal.

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