Scarborough Cross Country Ski Club

Membership Application & Renewal Form

PLEASE PRINT CLEARLY

NAME: ____________________________________________ Date of Birth __________________________

ADDRESS:________________________________________________________________________________

CITY: __________________________________PROV. __________ POSTAL CODE: __________________

PHONE: (_____)_________________________ E-MAIL: _________________________________________

Membership Fees for the Club Year November 1 to October 31 are $20.00

Renewing Member * New Applicant *

Membership requirements:

Membership Application (completion of this form)

Cheque for $20.00 Cheque # _________________ Cheque Date: ______________

Cross Country Canada – SIGNED “Informed Consent & Assumption of Risk Agreement”

RELEASE FROM LIABILITY

Release: Membership will not be accepted unless signed

In making application to participate in activities of the Scarborough Cross Country Ski Club, I/we affirm to be in good health, capable of the required effort needed to participate in club activities and accept as my/our personal risk the hazards of such participation. I/we release the Scarborough Cross Country Ski Club, its executives, directors, instructors, trip organizers and trip leaders from any liability whatsoever for loss, damage or injury (including death) howsoever caused which may result from my/our participation in any activity organized by the club. I/we declare that the Release is binding upon my/our heirs, executors, administrators and assigns. I/we the undersigned have read and understand the Release and agree that participation in club activities is entirely at my/our own risk.

_________________________________ ________________________________ _________________

Signature of applicant Signature of witness (not family member) Date

How did you hear about the Scarborough Cross Country Ski Club?

Word-of-mouth * Brochure * Website * Publication * Other * (please specify below)

__________________________________________________________________________________________________

In case of accident please notify:

Name: _______________________________________ Phone: _____________________________________________

Mail Membership Application & Cheque to: Scarborough Cross Country Ski Club

Box 97534, 364 Old Kingston Road

Toronto, ON M1C 4Z1