P.U.S.H. Elite Year 2 Life After Sports Registration Monday, June 20, 2016 5:30 PM 17:30 Sunday, July 3, 2016 6:30 PM 18:30 Google Calendar ICS Personal Information Name * First Name Last Name Birthdate * MM DD YYYY Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Home Phone * (###) ### #### Alternate Phone (###) ### #### Medical Information Emergency Contact Name First Name Last Name Relationship Home Phone (###) ### #### Business Phone (###) ### #### Health Card Number Is there any medical information that you would like us to know? Indicate participant’s name. List 2 careers in the sporting industry you ARE YOU Interested in learning about? P.U.S.H ELITE PROVIDES A HEALTHY MEAL AT PROGRAMMING WHAT are your food preferences? Halal Vegetarian Regular OUR STAFF IS COMMITTED TO 20 HOURS PER WEEK SO WE ASK PARICIPANTS WHO JOIN LIFE AFTER SPORTS PROGRAM TO COMMITT TO ATTENDING up to 20 HOURS PER WEEK. Thank you!
