1. Pickering Rouge Canoe Club’s 2014 Dragonboat Registration Club Program Additional details regarding each program are on the website (www.pickeringrouge.ca) Program Dates Club Registration Fee (HST included) Volunteer Cheque (hours) Recreational – PRCC provides the opportunity to try Dragonboat once a week for the duration of the summer. Fun environment - no experience necessary. See Regatta info below. May 5 th – September 3 th Mon or Wed Nights 6:30pm to 7:30pm $260 $100 (10 hrs) Development – 2 night/week program with a more competitive atmosphere - striving to do well at local regattas. See Regatta info below. May 5 th – September 3 th Mon & Wed Nights 6:30pm to 7:30pm $410 $100 (10 hrs) Drop-in Rate – opportunity to try a night on the water and get the feel for what the sport of Dragonboat offers!! Any Recreation times or. Contact Darren Mossman. $10.00 per session N/A BUILD YOUR OWN TEAM!!!!Contact: Darren Mossman(darrenmossman8@gmail.com) Mailing Information: PRCC 91 Rylander Blvd, Unit 7, Box 187 Scarborough, Ontario, M1B 5M5 Or forms can be dropped off in our mailbox inside the West Rouge Community Center www.pickeringrouge.ca Last NameFirst NameAge AddressCity/TownPostal Code Telephone (Home)Telephone (Cell / Other) Email Address (REQUIRED FIELD)Birthday: M D Y _ _ / _ _ / _ _ _ _ Health Card Number Emergency Contact Info Name: _______________________________________ Relationship to Paddler: ______________________________ Telephone: ______________________________________ PAYMENTS CAN BE MADE BY CASH OR CHEQUE ONLY. PLEASE MAKE CHEQUES PAYABLE TO THE PICKERING ROUGE CANOE CLUB. VOLUNTEER CHEQUES SHOULD BE POST-DATED TO OCTOBER 1, 2014 REGISTRATION IS NOT CONSIDERED PAID UNTIL VOLUNTEER CHEQUE HAS BEEN RECEIVED.

2. Membership Confirmation: All memberships are non-transferable. Membership is not considered to be paid until Volunteer Cheque has been received. All refunds will be subject to a $35.00 administration fee. A full refund will be granted within 7 days of purchasing a membership with an e-mailed request. All other refunds are less a prorated amount for the number of days the membership was active. Memberships are active from the date of purchase. They become non-active at the end of the season or upon our receipt of your application for refund. Any refund will take approximately 2 – 4 weeks. Refunds will only be considered for medical reasons with proper medical documentation. Non-use will not be considered a reason for a refund of membership. Pickering Rouge Canoe Club reserves the right to change schedules, coaches or practices as needed without compensation or notice. Refunds are not given for inclement weather. Your club membership includes: All practices for your program, coaching, paddling insurance, use of club boats, paddles, life jackets and other equipment, and admission to the year end celebration BBQ. ALL REGATTA FEES ARE THE RESPONSIBILITY OF EACH PADDLER. Regatta Fees must be paid to the Club Treasurer prior to the regatta. In consideration of acceptance, I ______________________________ for myself and on behalf of my child and for my heirs, executors, administrators, successors and assigns hereby release, waive and forever discharge the Pickering Rouge Canoe Club (hereinafter called “PRCC”), its directors, club officials, volunteers, members, organizers, employees, coaches, sponsors, and administrators (hereinafter called the “Release”) of and from all claims, liabilities, demands, damage costs, expenses, actions, and causes of actions, whether in law or in equity, of every kind of nature whatsoever, in respect of death, injury, loss or damage to any person property, howsoever caused including but not limited to the negligence of any of the Releases, arising out of or in any way related to or connected with my or my child’s participation in practices, competitions, training camps or any other activities of the PRCC, or any travel incidental thereto. I warrant that I/my child am/is physically and mentally fit to participate in the practices, competitions, training camps, or any other activities of the PRCC and that I/my child is an able swimmer. I understand that canoeing is a dangerous activity that exposes participants to many hazards and risks, which I accept as a condition of my/my child’s membership in the PRCC. I hereby acknowledge having read, understood and agree to accept the terms and conditions of this Release. I hereby apply for membership in the Pickering Rouge Canoe Club and agree to obey all Club rules as posted. ____________________________________ *Applicant’s/Parent’s Signature Date Place your initials here _______ if you DO NOT give permission for your/your child’s picture to be used by the Club for promotional activities. * Parent or guardian to sign on behalf of child if child is under the age of 18 years. Office Use Only:  Cheque  Cash Database Updated ___________ Padtrac Updated ___________ Amount Received:Date Received:Date Deposited:Date of Refund: ____________________________________________ Minimum Volunteer Hours Cheque: Cheque Received Date:Cheque Returned Date:Cheque Destroyed Date:Cheque Deposited Date: ____________________________________________