Club Registration

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

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Which club are you registering for?

Boots & Pearls Line Dancing

Country School Quilters

Hanover Herb Guild

Schoolhouse Investors

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

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Participation Waiver *

I, the undersigned participant/parent or guardian, if under eighteen, desire to participate in the Montpelier Center for Arts & Education programs and all special events, hereby release and agree to indemnify and save harmless Montpelier Center for Arts & Education, their employees, and any official of the special activity from any and all claims of any nature for illness, injury or loss that may result in such participation or preparation for such participation.

I agree

Photo Release *

I hereby fully consent to allow The Montpelier Center for Arts and Education to use photographs taken during this club for publicity purposes.

I agree

No thank you