Stirling Curling Club - CB Registration

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First Name

Last Name

Gender

Year of Birth

Photo Consent

Address

Address 2

City

Zip Code / Postal Code

Country

State / Province

Mobile Phone

Home Phone

Emergency Contact Name

Emergency Contact Relation

Emergency Contact Phone #1:

Emergency Contact Phone #2:

Full Time Student?

Smart Serve certified?

# of Years Curled

Skill Level

Referred to the Club by

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433 West Front Street
Stirling, Ontario   K0K 3E0
613-395-4444
[email protected]

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