Please provide all requested information. Note that all areas must be filled in to complete registration
Parents Email (used to contact)
Home Phone Number
Cell Phone Number
Please Select the TOP 3 WEEKS and Time of preferred session
What is your most preferred Week and Time
Program fee: $200.00 (includes Taxes and Rowing Canada/Rowing BC Membership Fees). $160.00 for 4 day week. $120 for FALL session Rowers who have completed a previous Learn to Row course receive 20% off. Receive 10% off your registration if you sign up 2 friends in the same week. Cheques are made to FLYRS. Following completion of the Learn to Row course, youth are eligible to row for the remainder of the summer at a cost of $75 per week.
EMERGENCY CONTACT INFORMATION
Emergency Contact's Name: (Other than parents)
Relationship to Rower
Care Card #
Date of last tetanus immunization
Medications taken on a regular basis
Medical conditions currently under treatment
Pre-existing physical conditions under treatment
Contact Lenses or Glasses
Any other notes that may be of assistance to coaches and/or chaperones:
I hereby give permission for the Fort Langley Youth Rowing Society to be responsible for providing medical supervision and treatment of my child if required.
RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
Complete this part ONLY if Participant is under 19 years of age
I, the parent and/or legal guardian of the Minor Participant, understand the nature of rowing and the Rowing Activities and the Minor Participant’s experience and abilities. I believe that the Minor Participant is medically fit and able to participate in the Rowing Activities without limitation. I have read, understand and agree with the terms of the foregoing Agreement and will ensure that the Minor Participant fulfills the Participant’s obligations thereunder, and I HEREBY RELEASE AND FOREVER DISCHARGE THE RELEASEES and each of them from any and all liability, claims, demands and costs for any loss, damages, expenses or injury, including death, that the Minor Participant or any of the Minor Participant’s next-of-kin may suffer due, or alleged to be due, to any cause whatsoever, in whole or in part, including but not limited to negligence, breach of contract, breach of any statutory or other duty of care, including any duty under the Occupiers Liability Act, of the Releasees or any of them, and further including but not limited to failure on the part of the Releasees or any of them to safeguard and protect the Minor Participant from the Risks and the dangers of the Rowing Activities, and negligence in any rescue operations any of them may undertake. If, despite this Agreement, I, the Minor Participant, or anyone on the Minor Participant’s behalf makes a claim against the Releasees or any of them, I will indemnify, save and hold harmless the Releasees and each of them from any liability, claims, demands, loss, damages or costs which they or any of them may incur as a result of that claim.
How did you hear about Learn to Row?
Any questions, comments, concerns?