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Blue Jays Girls Day Clinics
All fields marked with an asterisk (*) are required for your submission.

 Participant Information
* Clinic
* First Name * Last Name
* Birth Year
Allergies Medical Conditions

 Parent/Guardian Information
* First Name * Last Name
* Address Address 2
* City * Province
* Postal Code
* Day Phone Evening Phone
Mobile Phone * Email Address

 Payment Information
* Name on Card * Card Number
* Security Code What is this?
* Expiration Date
* Card Type
Amount to Charge
The amount charged to your credit card will include applicable sales taxes. Your billing confirmation email will include the amount of sales tax charged.

 Collection and Use of Information

 Participant Release, Indemnity and Licence Agreement
Print Agreement


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