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REGISTRATION FORM FOR THE 2017 CURLING SEASON

STEP 1 OF 3: Enter registration details

Note that all required fields are marked with **


Enter Contact Details:

First Name: **
Middle Name:
Last Name: **
Gender: **
Address: **

City: **
Province/State: **
Postal/Zip Code: **
Country: **
Home Phone: **
Mobile Phone:
Work Phone:
Ext.:
Member Since: **
Years Curling Experience: **
Email:

Please enter your email address here. Email is the primary method used to communicate with our members and is only used for that purpose. If you do not have an email address please leave this field blank.

Re-enter Email:
Emergency Contact (If youth, enter parent): **
Emergency Contact Phone Number: **
Date of Birth: **
Youth members are required to enter their full date of birth including the year. If you want to take advantage of any available age discounts you must enter your full date of birth including the year.

Consent to Release Information, Privacy Policy and Anti-Spam Policy: **

I hereby consent to the use of the personal information provided above by the Chinguacousy Curling Club administration. Only my name and phone numbers will be listed in the membership directory and/or website for general member use. This information is intended for the sole use of Chinguacousy Curling Club and will not be shared outside the Club.


Injury Waiver: **

In consideration of acceptance of this registration by Chinguacousy Curling Club ("the club"), I HEREBY RELEASE, WAIVE AND FOREVER DISCHARGE the club and each of its members, officers and employees FROM ANY AND ALL claims, demands, damages, costs, expenses, actions and cause of action, whether in law or equity in respect of death, injury, loss or damage to myself or property, arising or to arise by reason of my participation in the club, that has not been contributed to or occasioned by any negligent act, by omission or commission, of any of the aforesaid.


Registration Selection: **

Select the membership type first by checking on the appropriate round checkbox. If registering for a membership type that also has league selections please check all the square checkboxes for the leagues in which you wish to play. Please show all team member names for choose your own leagues, each team member must submit their own form. Not on a team? Write assign for the other team members.

League Curling

Adult Regular Member

Business Women - Enter your team members.  If you are missing a team member - enter Assign.

Skip: ** 
Vice-Skip: ** 
Second: ** 
Lead: ** 

Day Ladies (Tuesday) - Enter preferred position.

Notes for Convenor (Day Ladies - Tuesday): 

Daytime Open (Thursday 9:30am) - Enter preferred position

Notes for Convenor (Daytime Open): 

Men's league

Monday or Tuesday Night

Notes for Convenor (Men): 
Skip: ** 
Vice-Skip: ** 
Second: ** 
Lead: ** 

Men - Monday - Enter your team members.  If you are missing a team member - enter Assign.

Skip: ** 
Vice-Skip: ** 
Second: ** 
Lead: ** 

Men - Tuesday - Enter your team members.  If you are missing a team member - enter Assign.

Skip: ** 
Vice-Skip: ** 
Second: ** 
Lead: ** 

Mixed - Friday 7:00 - Enter your playing partner's name, Vice/Skip or Lead/Second.  Enter alternate choice for draw.

Notes for Convenor (Mixed - Friday 7 pm): 

Mixed - Friday 9:00 - Enter your playing partner's name, Vice/Skip or Lead/Second.  Enter alternate choice for draw.

Notes for Convenor (Mixed - Friday 9 pm): 

Mixed - Sunday 7:00 - Enter your playing partner's name, Vice/Skip or Lead/Second.  Enter alternate choice for draw.

Notes for Convenor (Mixed - Sunday 7 pm): 

Mixed - Thurs 9:00 - Enter your playing partner's name, Vice/Skip or Lead/Second.  Enter alternate choice for draw.

Notes for Convenor (Mixed - Thurs 9:00): 

 

Ages 7-20

Youth - Sunday 1:00 pm


Special Membership Options

OCA - Adult

OCA - Junior

Social


Registration Discount Options

Discount to New Members applicable to:

1. The 1st league FULL ADULT membership rate (Not applicable with any further discounted rates such as Student Rate or Youth Leagues)

2. And who is NEW to the Chinguacousy Curling Club or has been away from the club for a period greater than two years.

Discount for Student curlers. Students ~ aged 18 to 25, who are enrolled full time in school



Registration Accuracy Confirmation: **

I hereby confirm that the information I have entered on this form is correct and true. I understand that if I have intentionally entered false information in this form to receive discounts that do not apply to me there will be a $25 administration charge on top of the outstanding membership dues owed.



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