PDPC Membership Form 2012

Regina Dragon Boat Festival Inc.

Dragon Boat Regina

2013 Membership Application

Privacy Statement

Please providethe following information for your membership record, and indicate “Yes”or “No”whetheryouarewilling to have that information published to the Festival’s Executive Board in the form of a contact list. Information collected may only be viewed by the Board of Directors and/or Training Coordinator and coaches for the purpose of safety, bookkeeping, coaching and official Festival communications.

Member Information: / Release Info
Individual Name/Team Name:
(use team name only if applying for team registration) / Yes or No
Address: / Yes or No
Home phone: / Work: / Cell: / Yes or No
Email: / Yes or No
Birth date: D/M/Y (optional unless opting for the Dragon Boat Canada individual membership.) / Yes or No
If applicable, list team(s) youare currentlya member of:
Areyou a member of any other paddling association in Sask. or Canada? Ifyes please list:
Doyou have anydragon boat coachingor steering experience? Ifyes, please describe:

EmergencyContact Name: EmergencyPhone Numbers:

Doyou have amedical condition or physical limitation the coaching staff should be awareof? This might include conditions that can be affected bydehydration, strenuousexercise or allergies to medications or insects.Yes or No

If yesdescribe:

***MEMBERSHIP FEES ARE NON REFUNDABLE***

Please submityour completed forms along with payment to The Regina Dragon Boat Festival Inc.

(c/o Box 26079, Regina, SK)

Member Fees: / AmountPaid
Required / Annual Dragon Boat Regina fee ($40.00) – Voting member
Required / Annual Dragon Boat Regina fee ($30.00) – Non-voting member
Note: Individuals belonging to other paddling clubs or associations in Saskatchewan may not hold a voting membership.
Optional / Dragon Boat Canada (DBC) –Individual Membership fee $21.00 ($20 plus GST)
Note: the DBC membership is required if you wish to join the Competitive Dragon Boat Regina team.
OFFICE USE ONLY / MEMBERSHIP # / DATE PAID: / TOTAL:

Volunteering

As a member of Dragon Boat Regina, there may be an expectation that you volunteer some of your time in the following areas: special events and/or community activities, steering, coaching, officiating, advertising/promotion, equipment maintenance, lottery, membership and accounting.

WAIVEROFLIABILTYRELEASE

All members are subject to the Bylaws of the Regina Dragon Boat Festival Inc. (“RDBF” or the “Festival”) which apply also to Dragon Boat Regina and the Regina Dragon Boat Club, who are subsidiary Club organizations of the Festival.

INDEMNIFICATION ANDHOLDHARMLESSNOTICE

Please note for thiswaiver, the Regina Dragon Boat Festival Inc. and Dragon Boat Regina or the Regina Dragon Boat Club includes their respectivedirectors, members, trustees, agents, representatives,officers, sponsors, licensors, servants, volunteers andemployees.

1. In consideration for receiving permission toparticipate inthe Regina Dragon Boat Fesitval Inc. and Dragon Boat Regina activities, the receipt of said permission being hereby acknowledged,I do hereby forever RELEASE anyandall liability, discharge and agree not to sue the REGINA DRAGON BOAT FESTIVAL INC. and/or the Festival subsidiariesand agree to and save them HARMLESS AND INDEMNIFY them from and against any and all liabilities, claims, injuries, losses,damages, expenses, demands, actions, and causes of action ofwhatsoever kind or nature arising out of or related to anysuch loss, damage, or injury, including death,etc. that maybe sustained byme for whatever reasonwhile soparticipating in theRDBF activities and/or subsidiary Clubwhethersuch damages are theresult of negligence or for any other reason or cause.

2. I also agree to discharge forthwith on request ofthe RDBF and their authorized representatives each and everyobligation orclaimwhich shall be made, assigned or apportioned againstthe RDBF and its subsidiary organizations andtheir respective directors, agents, members,trustees, representatives, officers, sponsors, licensors, servants,volunteers and employees by any partybyvirtue of anyinjuryor damage caused byme or to me absolutely.

3. I and mynext-of-kin are dulyaware of the risks and hazardsinherent in both the sport ofpaddling and entering thepremises used for the purpose of launching, docking and storing equipment used inthe sport of paddling, and specificallyin participating in the Regina Dragon Boat Festival Inc and/or subsidiary clubs and the practice sessions and participating in events, knowing conditions may be hazardousanddangerous and that obstructions may exist, and that highwinds may cause roughwater,and that I herebygive notice that I am a competentswimmer and/or will wear the personal floatation devices as required and that I voluntarily assume all risks of loss,damage or injury, including death, that may be sustained byme or to anyproperty while engaged in said festival and club activities.

4. In signing the foregoing release, I herebyacknowledge and represent that I have read the foregoing release, I understand it and agree to it voluntarily, thatI am 18yearsof age or older,and of soundmind.

MINORS ONLY:

5. In signing the foregoing release, I hereby acknowledge and represent that I and a parent or legal guardian has read the foregoing release, I understand it and agree to voluntarily, that I am under the age of 18 years, and of sound mind.

Member’s SignatureWitness and/or Parent/Legal Guardian Signature (please circle)

Printed NamePrinted Name

Date SignedDate Signed