I, the undersigned participant in one or more Brockville 50+ Activity Centre activities, as a condition of my participation, hereby for myself, my heirs, executors and administrators, waive any and all claims, in connection with or arising out of my participation or any injury to myself related hereto, I may have now or in the future against the Brockville 50+ Activity Centre, its class or activity organizers, instructors, leaders, and other volunteers.
I, the undersigned participant, also understand that it is my responsibility to report any accident or personal injury to the 50+ office within 24 hours of occurrence (This is to ensure compliance with government health and safety regulations.)
I, the undersigned participant, also understand it is my responsibility to ensure I have the ability and stamina to participate in the activities for which I am applying.
I also hereby authorize the Brockville 50+ Activity Centre to routinely correspond with me using the email address already on file or as provided on the current registration form.
I acknowledge that I have read, I understand and I agree to the terms and conditions of the Brockville 50+ Activity Centre Participant Waiver of Liability Agreement.
NOTE: ONLY THE APPLICANT OF THIS FORM CAN ENTER THEIR OWN SIGNATURE in the following signature panel. A person who may be assisting you does not have the legal authority to sign a waiver for you. If using a PC use your mouse, if using a mobility device use your finger tip. Do the best you can, it won't be perfect.
Your browser does not support e-Signature field.
If you have selected at least one activity and do not have a Priority Violation you will now be able to push the Review Answers Button to make sure all your information and selections are correct.
After reviewing your information you can either use the Back to Form button to correct any information or click the Submit button to complete the application.
