VCB Membership - Under 19 years old.

published by J. Cote on Fri, 2012-03-09 21:55

VCB Membership Application - under 19 years old. ($5. for the entire year)

Mail-in application with paper copy of VCB Membership Application form.

Note: Please allow 2 - 3 weeks for processing.

First, Last name *

Address *

City, Province, Postal Code *

Date of Birth *

Year

Month

Day

As we know for sure who is under 19 and needs guardian/parent signature with respect to waivers (this bit of data also helps with statistics and may improve VCB chances of success when seeking grants or approvals).

email *

Gender *

Female

Male

Phone Number

MEMBERSHIP DIRECTORY: Name, city, email and phone will be shared only to the present membership. Do not show:

City

Phone Number

PHOTO RELEASE: Photographs of me taken at events organized by Velo Cape Breton may be used for promotional or educational purposes. *

I Agree

DO NOT Agree

RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT

In my name/the name of my child, I am aware that the participation of me/my child in bicycling activities involves certain danger and risks and I freely and fully assume all such danger and risks and the possibility of personal injury, death, property damage or loss resulting there from. I, for myself/my child, my heirs, next-of-kin, executors, administrators and assigns, hereby release the Velo Cape Breton Society, its officers, directors, members and volunteers from any liability, and waive all claims, causes of actions of any kind whatsoever I may have as a result of me/my child sustaining personal injury, death, property damage or loss while participating in any Velo Cape Breton Society activities or events.

I, for myself/my child, my heirs, next-of-kin, executors, administrators and assigns hereby agree as follows:

1. to waive any and all claims that may result against Velo Cape Breton Society, its directors, officers, volunteers, sponsors and members all of whom are hereinafter referred to as the “releasees”;

2. to release the releasees from any and all liability for any loss, damage, injury or expense that I/my child may suffer or that my next-of-kin may suffer as a result of my/my child’s participation in said events and activities;

3. to harmless and indemnity the releasees from any and all liability for any property damage, personal injury or death to any third party from my/my child’s participation in said events and activities.

In Lieu of a Signed Waiver, Do You Accept the Above Release? *

Yes

Please print this membership form for your records

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VCB Membership - Under 19 years old.

VCB Membership Application - under 19 years old. ($5. for the entire year)

RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT

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dropdown menus

2013 Programs

Velo Cape Breton newsletter

You are here

VCB Membership - Under 19 years old.

VCB Membership Application - under 19 years old. ($5. for the entire year)

RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT