Buffalo Canoe Club - Junior Registration Forms

Junior Program Registration Forms

SAVE THE DATE: JA Awards Dinner & Dance, Thursday August 23, 2012 @ 6:00pm. Please RSVP by August 15, 2012, as every child that attends receives an award!

Please complete one form per person per class. If you or your child is attending more than one program, please complete another form for him/her or yourself. Please note the restrictions on dates and minimums under the class descriptions. If you enter an invalid date/time your registration will not be accepted. Non-members will be charged an additional 20%.

Member Number (non-member enter NA and provide credit card payment below)
Member First and Last Name
Child's First and Last Name
Child's Age & Date of Birth
Please Select the Program
Please provide the dates you wish to register for and note any class restrictions to ensure your registration is valid (i.e. 2 week minimums and specific dates)
Do you or your child have any allergies or medical conditions? If yes, please specify.
Non-Members please provide your address and home phone number. (Enter NA if you are a member)
Non-Members please provide a Visa/MC number with expiry date
Emergency Contact Name and Phone #
You MUST provide your insurance provider and policy number or health card number
Please provide your email address for confirmation and information / parent package.
You must be 18 years of age or older to register in any of our programs or are the parent/legal guardian of a child participating in our programs. I recognize that sports can be dangerous and assume all risk of injury, loss or damage to my person and/or property while upon the property or vessels owned, leased and/or under the care and control of the Buffalo Canoe Club, its servants and/or agents. Furthermore, neither I nor any other person under my authority/supervison shall have any right nor claim againt the Buffalo Canoe Club, its servants and/or agents. I understand that photographs and video may be taken of participants for promotional purposes and I hereby consent to such use by the Buffalo Canoe Club. *I agree to the terms and conditions. (Must Type in YES)
Cancellation & Amendment Policy: A $50.00 fee will apply for any cancellations or changes that are received. There are NO REFUNDS OR SCHEDULE CHANGES 7 days prior or less then 7 days prior to the course start date. In the event you or your child is ill, no refunds or make-up days can be made. For full session rates, you must sign up for all 4 weeks in that session, otherwise, the weekly rate is applied. *I agree to the Cancellation/Amendment Policy (Must Type in YES)