3310 Palmer Drive, Burlington, ON  L7M 1X3

905-634-2012 or 1-877-877-4550

outdoor@spectranet.ca

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 cheque payable to: THE HALTON OUTDOOR CLUB....... Mail to : THE HALTON OUTDOOR CLUB, 3310 Palmer Drive, BURLINGTON, ON  L7M 1X3

Membership Fees for 2009/10 (Nov 1)
Single.....$45.00
Family.....$75.00 (includes parents and all family members 18 years and under)
Student...$25.00 (full time students of any age)
Single (partial year).....$20.00 (First time membership only(*)...applies from May 1st to August 31st - does not apply to renewals)
Family (partial year).....$35.00 (First time membership only(*)...applies from May 1st to August 31st - does not apply to renewals)

(*)...Applications received after August 31st must be at regular prices and apply to the balance of current year and the following year!

Last Name_________________________   First Name_______________________

Street_____________________________   City_____________________________

Postal Code_________________________  Phone: (Res.)______________________

Phone: (Bus.)________________________

Child (Name, Age)____________________ Child (Name, Age)_________________

Please check any of the following activities you are interested in helping with: Telephone Work Club Executive Newsletter
Publicity Social Committee Secretarial Nordic Ski Patrol Instructor Organizing Events 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 damge 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.

Please note this waiver shall apply for so long as the undersigned is a member of the club.

Dated at __________________this____of______________,20___

Applicant's signature:_____________________________ 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.