AJAX SENIOR CITIZENS FRIENDSHIP CENTRE AND PICKERING & VILLAGE SENIORS CLUB

MEMBERSHIP APPLICATION

Assumption of Risk and Release and Waiver of Liability Indemnity Agreement.

You are urged to consult with your family doctor prior to participating in programs and or events offered by Ajax Seniors Citizens Friendship Club and/or Pickering and Village Seniors Club

Release and Indemnification

Ajax Seniors Citizens Friendship Club/Pickering and Village Seniors Club will make available the opportunity of participating in activities and programs to its members. These programs or activities’ may present various elements of risk. Accidents resulting from such activities may occur and cause injury. The participants assume the risk associated with the activity.

Acknowledgement
Waiver of Liability
Photo Release Policy

Collection of Personal Information

Personal information collected on this form is collected pursuant to the Municipal Act, 2001, s. 11(1), and will only be used for the purpose for which it is collected, and will not be distributed or used by the Town of Ajax for any other purpose. Questions about this collection may be directed to the Town of Ajax Records and Freedom of Information Coordinator at 65 Harwood Avenue South, Ajax, Ontario, L1S 2H9 or 905-683-4550.

Learn more about the Town of Ajax's Privacy Policy.

Accessibility

If you require this form in an alternative format, please contact the Town of Ajax Accessibility Coordinator, at 905-683-4550, or by e-mail at contactus@ajax.ca.