3310 Palmer Drive, Burlington, ON  L7M 1X3

905-634-2012 or 1-877-877-4550

outdoor@spectranet.ca

Print out Application Form and fill in by hand.

 

The release and waiver must be signed by all members 18 years and over and must also be witnessed by a non-relative.

Please make cheque payable to THE HALTON OUTDOOR CLUB and mail to the Club at 3310 Palmer Dr., Burlington ON, L7M 1X3

Membership Fees for November 1, 2010 to October 31,  2011.
Individual.....$50.00                 Student.........$30.00  (fulltime students of any age)
Family...........$85.00 (includes parents and all family members 18 years and under)
Partial year for first time members only applies from May 1 till August 31, but not to renewals.

Individual (partial year).....$25.00                Family (partial year)......... $45
If applying after August 31, please use regular prices - and it gives you the balance of the current year plus the following year!

Last Name_________________________   First Name_______________________

Street_____________________________   City____________________________

Postal Code_________________________  Phone: (Res.)_____________________

Phone: (Bus.)________________________  e-mail ___________________________

Child (Name, Age)____________________ Child (Name, Age)_________________

Please check any of the following activities you are interested in helping with:Telephone WorkClub Executive Newsletter Publicity Social Committee Secretarial Nordic Ski Patrol Instructor Organizing Events Other (specify)

Release and Waiver

In consideration of The Halton Outdoor Club (the"Club"), accepting my/our application for participation in an activity of/or organized by the Club, I/we,_____________________________ hereby for myself/ourselves, our heirs, executors, administrators and assign, release and forever discharge the Club, its servants, agents, sponsors, employees, and/or members from any and all claims, demands, damages, actions or causes of action arising out of or in consequence of any loss, injury or damage to my/our person or property incurred while attending at or participating in any activity of, or organized by the Club, notwithstanding any such loss, injury or damge may arise by reason of the negligence of the Club, its servants, agents, sponsors, employees and/or members. Without limiting the generality of the foregoing, I/we further release any and all recourse which I/we may now or hereinafter have resulting from any decision of the Club.

Dated at __________________this____of______________,20___

1. Applicant's signature:_____________________________ 2. Applicant's signature:______________________________

Signature of witness:_________________________________

Note: A separate indemnity is required to be completed by parents of children under 18 years of age. This will be sent to you after receipt of the above application for family membership, where children are included.