GRANDE PRAIRIECANOE CLUB

6446 – 96 A Street

Grande Prairie AB

T8W 2B4

MEMBERSHIP APPLICATION FORMYear: 201_

FEES:Individual$15.00

Family$25.00

NAME: ______HOME PHONE: ______

ADDRESS: ______WORK/CELL PHONE: ______

______POSTAL CODE: ______

E-MAIL ADDRESS (if available): ______

FAMILY MEMBER’S NAMES: ______

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PLEASE INDICATE YOUR BOATING INTERESTS:(YES, NO OR MAYBE)

Day Trips Y N M / Extended Wilderness Trips Y N M / Instructing Y N M
Canoe Camping Y N M / Safety and Rescue Y N M / Whitewater Y N M
Flatwater Y N M / Trip Co-ordinator Y N M / Social Events Y N M

Do you need a paddling partner?Yes____No____

WHAT ARE YOU LOOKING FORWARD TO AND WHAT ARE YOUR EXPECTATIONS CONCERNING THE GRANDE PRAIRIE CANOE CLUB?

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HEALTH AND MEDICAL INFORMATION

NAME: ______

EMERGENCY CONTACT: ______

FAMILY PHYSICIAN: ______

DO YOU HAVE ANY FOOD, ANIMAL, INSECT, and MEDICAL OR ENVIRONMENTAL ALLERGIES?

PLEASE LIST: ______

DO YOU SUFFER FROM ANY HEALTH CONDITIONS THAT MAY CAUSE A CONCERN WHILE ON A TRIP? ______

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WAIVER RELEASE AND ASSUMPTION OF RISK

The following release of liability must be read, understood, and signed before embarking on a trip or function with the Grande Prairie Canoe Club. Information regarding the trip, associated risks, and the Standard Operating Procedures that may be involved will be provided by Grande Prairie Canoe Club.

By signing below, I acknowledge that I have received adequate information regarding the risks I may face while on a trip, and that all those activities may be hazardous and may result in accident, loss, damage, injury or death to person or property as a direct result of Acts of nature, delays, thefts, or vandalism.

With full knowledge of these dangers, and intending to be legally bound, I hereby agree for myself and on behalf of all my family and heirs to RELEASE the Grande Prairie Canoe Club and any of its agents, representatives, and members from any and all liability, claims, demands or any causes of action, and NOT TO SUE OR OTHERWISE MAKE ANY CLAIMS against the Grande Prairie Canoe Club or any of its agents, representatives or members whatsoever may arise during my participation on any trip with the Grande Prairie Canoe Club.

I agree to be solely responsible for my safety and to take every precaution to provide for my own safety and well being while participating in any Grande Prairie Canoe Club function. This RELEASE AND WAIVER has no expiration date.

Signature: ______Signature: ______

Date: ______Date: ______

GRANDE PRAIRIE CANOE CLUB

6446 – 96 A STREET

Grande Prairie, AB

T8W 2B4