The Halton Outdoor Club
Membership Application Form
Includes Release and Waiver
3310 Palmer Drive, Burlington, ON  L7M 1X3
905-634-2012 or 1-877-877-4550
outdoor@spectranet.ca

Please fill in Application Form by using your keyboard, print it and sign 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 your cheque payable to The Halton Outdoor Club and mail to the club at 3310 Palmer Drive, Burlington ON, L7M 1X3.

Membership Fees for November 1, 2011 to October 31, 2012.

Individual $50.                     Student $30. (full time students of any age)
Family $85. (includes parents and all family members 18 years and under)

Partial year for first time members only, applies from May 1 till October 31, not for renewals.

Individual (partial year) $25. Family (partial year) $45.

If applying after August 31, please use regular prices - and it gives you the balance of 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 activities you are interested in helping with: Secretarial, Instructor, Publicity, Nordic Ski Patrol, Newsletter, Trip Leader, Organizing Events, Telephone Work Club Executive, 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 damage 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.