MEMBERSHIP APPLICATION FORM

First name

Last name

Address Line

City

Postal Code

Phone number

Birthday

Year

Month

Day

Emergency Contact Name

Emergency Phone #

What's your timeline or preferred start date?

Release and Indemnification

Ajax Seniors club (St Andrew’s Friendship Centre/Pickering Village centre) will make available the opportunity of participating in activities and programs to its members. These programs or activities may present various elements of risk. Accidents resulting from such activities may occur and cause injury. The participants assume the risk associated with the activity.

Waiver of Liability

I hereby release Ajax Seniors Club (St Andrew’s Friendship Centre / Pickering Village centre) board of directors and coordinators from all liability, unless caused by them through negligence, for any injury sustained by me, resulting from my participation in the activity arranged by the club. This document shall only be considered an acknowledgement of risk and will not absolve Ajax Seniors Club (St Andrew’s Friendship Centre / Pickering Village centre) of negligence arising out of their operations.

I have read and understand the Waiver of Liability and agree to participate at my own risk. By checking this box, I confirm my acceptance of the waiver terms.

Photo Release Policy

I understand that photographs taken of me participating in the events or programs can be used wholly or in part for publications associated with Ajax Seniors club (St Andrew’s Friendship Centre/Pickering Village centre).

I give permission for photos taken of me during Ajax Seniors Club activities to be used for club publications and communications.

What led you to join the Ajax Seniors Club?

Renewal

Advertising

Word of Mouth

Friend