Registration Information
Athlete’s Personal Information (print clearly)
Last Name
First Name
Street Address, Apt. No.
City, Province, Postal Code
Home Phone Number
Cell Phone Number
Preferred Email Address
Date of Birth YYYY / MM / DD Sex: M
Years of Experience
Special Medical Conditions or Requirements
F
Height:
Weight:
Fill in this section ONLY if athlete is under age 18
Name of Parent/Guardian
Cell Phone Number
Email Address
Emergency Contact Information
Last Name
First Name
Home Phone Number
Cell Phone Number
Select a Membership or Indicate a Special Program
Level
Part-Time Membership
$200 for 1st season, $100 for each additional season
Summer
Fall
Full-Time Membership
$300 for 1st season, $150 for each additional season
Special Programs
Indicate below a description of the special program you are registering for (intermural,
camps, lessons, etc)
__________________________
$________
Make sure you and/or your parent/guardian completely read, understand and agree to the Waiver and
Release of Liability below as part of your membership agreement.
5454 Lyons Creek Road, Niagara Falls, Ontario, Canada, L2E 6S6
www.niagarafallsrowingclub.com
Waiver and Release of Liability
In consideration of my membership and participating in any and all activities related to the Niagara Falls
Rowing Club I acknowledge and agree that:
 Participating in rowing related activities has inherent risks that are similar to that of any other water
sport. I knowingly and freely assume all such risks.
 Rowing is a physically strenuous activity and I have consulted my own doctor, or waive that
consultation, and confirm that I am in sufficient physical condition to withstand all stresses related to
rowing activities.
 I will release and hold harmless the Niagara Falls Rowing Club, its officers, coaches, agents,
employees, volunteers, sponsors, fellow members or any other related persons not specifically
mentioned of any and all forms of injury or death.
 Niagara Falls Rowing Club may use photos or videos of me participating in rowing related activities
for promotional use.
 I can swim a minimum of 50 meters and can tread water for a minimum of 5 minutes wearing rowing
and/or weather related clothing.
 In exchange for free storage of my personal rowing equipment I permit Niagara Falls Rowing Club its
use when not in use by me.
 I will abide by all posted club rules, codes of conduct and regulations and will conduct myself with
the highest sportsmanlike conduct or risk disciplinary action including expulsion from the rowing
club.
 My personal information may be shared with other rowing clubs and associations as it pertains to
rowing activities.
 My payment will be made in full before I participate in any rowing club related activities.
 Registration payment by cheque will be made to Niagara Falls Rowing Club.
 Refunds are available up to two weeks after the program start date. There is a non-refundable $50
administration cost.
By completing the section below I agree to the above Waiver and Release of Liability
Athlete’s Name
Athlete’s Signature
Date
Parent or Guardian Name
Office
Use
Only
Cash
Or
Cheque
Amount
Parent or Guardian Signature
Date
Received By
Receipt No.
5454 Lyons Creek Road, Niagara Falls, Ontario, Canada, L2E 6S6
www.niagarafallsrowingclub.com