Name * First Name Last Name Date of Birth * MM DD YYYY Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Gender Male Female Unspecified Pickleball Canada Membership # * Skill Rating * Brand New to 2.5 3.0 3.25 3.5 3.75 4.0 4.25 4.5 5.0+ Was this Self Rated or Other? DUPR CTPR USAPA Self Rated Pickleball Brackets Other PIPA Information * To be in compliance with PIPA (B.C.'s Personal Information Protection Act) Christina Lake Pickleball Club advises that the collection of any and all personal data will be for the sole purpose of supporting you in your endeavours to play pickleball and the furtherment of the sport of pickleball. This information may be shared, where reasonable, with other organizations with the same pursuits, for example: The local pickleball club that you may be affiliated with; Pickleball Canada (PCO); A tournament committee if you have expressed interest in participating. Your personal data will NOT be shared, unless you have given specific authority to do so or as required by law, with any commercial venture or any other non pickleball association or interest. I Accept PIPA Emergency Contact Name * First Name Last Name Emergency Contact Phone * (###) ### #### Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement * ASSUMPTION OF RISKS I am aware that participating in the sport of pickleball involves many risks, dangers and hazards including, but not limited to: collision with other persons or objects; being struck by a paddle; being hit by a ball; the risk of stroke; heart attack; or other similar life threatening conditions caused by physical exertion; the risk of personal injury including but not limited to, strains, sprains, fractures, brain injury, spinal cord injury including paraplegia or quadriplegia, or death; loss of balance or control; slips, trips and falls; negligent first aid; failure to act safely or within one’s own ability; negligence of other persons; and, NEGLIGENCE ON THE PART OF THE RELEASEES. I UNDERSTAND THAT NEGLIGENCE INCLUDES FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE. I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH OR PROPERTY DAMAGE OR LOSS RESULTING THEREFROM. RELEASE OF LIABILITY, WAIVER OR CLAIMS AND INDEMNITY AGREEMENT In consideration of the the Releasees accepting my application for membership in the Christina Lake Pickleball Club and, as applicable, my affiliated province and local association or club, and permitting my use of the facilities and premises provided by the Releasees (hereinafter “the premises”), I hereby agree as follows: 1. TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against THE RELEASEES. and TO RELEASE THE RELEASEES from any and all liability for any loss, damage, expense or injury including death that I may suffer, or that my next of kin may suffer, as a result of my participation in the sport of pickleball including, but not limited to, my use of the premises DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER ANY PROVINCIAL OCCUPIERS’ LIABILITY LEGISLATION ON THE PART OF THE RELEASEES. I UNDERSTAND THAT NEGLIGENCE INCLUDES THE FAILURE ON PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE. 2. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to property of or personal injury to any third party, resulting from my use of or presence on the premises; 3. This Release Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity; 4. This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the Province of British Columbia and no other jurisdiction; and 5. Any litigation involving the parties to this Release Agreement shall be brought solely within the Province of British Columbia, and shall be within the exclusive jurisdiction of the Courts of the Province of British Columbia. In entering into this Release Agreement I am not relying upon any oral or written representations or statements made by the Releasees with respect to the safety of pickleball other than what is set forth in this Agreement. I agree Dates of your visit to Christina Lake BC? * As an Associate Member you've indicated you will be visiting up to 4 weeks this season. Can't wait to meet you! When will that be? Welcome to the Christina Lake Pickleball Club! Thank you for completing our Associate Membership form. Please send your $15 e-transfer to clpbtreasurer@gmail.com. To avoid mistakes, consider copying and pasting the email. We look forward to seeing you on the courts!