Edmonton Rowing Club

							                                                   Edmonton Rowing Club
                                                   High School Registration

  Please fill out the fields below and return the form to your coach or the school’s Teacher Contact. The High
                                                             th
  School Indoor rowing fee is $75, to be paid by March 10 , 2012. If you choose to continue with the program
  after the Indoor Erg Championship, the Outdoor Rowing fee will be an additional $75. If you do not complete
  online registration and payment, please make a cheque out to Edmonton Rowing Club and submit with form.

Name:___________________________________________________________                           O    Male     O    Female

Email address:____________________________________________________                         Π   T-shirt size (adult)

Street address:_________________________________________________________________________

Postal Code:__________________ Home Ph:__________________ Cell Ph: ______________________

Date of Birth (mm dd yyyy): _______________________________________________________________

High School: _____________________________________________________________ Grade: _______

Existing Medical Conditions? O Yes O No ________________________________________________

Name of Parent Contact:________________________________ Email:____________________________

Tax Receipt to be issued? (participant must be under 17 for at least one day in 2010) O Yes                   O     No

Name on the Tax Receipt: ________________________________________________________________

Informed Consent Agreement and Waiver:
I hereby acknowledge that participation in rowing might result in personal injury. I fully understand the risk and
hereby agree to participate voluntarily and at my own risk. In consideration of my acceptance and participation
in the Edmonton Rowing Club programs, I hereby for myself, my heirs, executors, personal representatives and
administrators, waive any and all rights of claim of damages I may have against the Edmonton Rowing Club
and/or their directors, officers, employees, coaches, volunteers, members, agents and representatives.
Furthermore I agree that the City of Edmonton, and/or Edmonton Catholic Schools, and/or Edmonton Public
Schools shall not be liable for any and/or all injuries sustained by me or in any way resulting from my
participation in Edmonton Rowing Club programs.

        O       I agree to abide by the Rules and Regulations of the Edmonton Rowing Club.

I have read and I understand that the training and regatta are offered by the Edmonton Rowing Club, and not
the Edmonton Area High Schools or School Boards. The High School Rowing program involves our Board of
Directors and ensures coverage through the insurance of Rowing Canada Aviron. Edmonton Rowing Club is
governed by the rules and safety procedures of the Alberta Rowing Association and Rowing Canada Aviron.

        O       I grant the Edmonton Rowing Club permission to disclose my personal information to register
                with Rowing Canada Aviron and the Alberta Rowing Association.

Signature of Student Applicant______________________________________ Date:_______________, 2012

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      Mandatory completion below if the applicant is under the age of 18 years at the time of Registration.

I have read the Informed Consent Agreement in its entirety. I hereby confirm that ___________________ has
my permission to participate in the Edmonton Rowing Club High School rowing program, that he/she is in
generally good health and is able to participate in this physically demanding activity, that he/she has medical
insurance through Alberta Health Care or a private health care plan.

_________________________                  _______________________                    Date:_______________, 2012
Signature of Parent or Guardian            Printed Name (Parent)

            Form must be completed and submitted along with fees before training commences.