Program Registration

Participant Information
JCC Member *
Participant's First Name *
Last Name *
Birth Date *
Parent's Full Name if under 16
Street *
City *
Province
Postal Code *
Email Address
Home Phone *
Emergency Contact *
Phone *

Program Information
Course / ProgramDate / TimeCodeFee
HST (will be added when applicable)
Total Fee

Optional Donation
Your continued support is important to us. Would you like to make a donation to the JCCGV? Please enter the amount, which will be added to your program total. You will be receiving a tax receipt in the mail. Thank you for your support!
Amount of donation
Name of Donor

Payment Information
I hereby agree to pay the full amount due corresponding with the prices listed. Registrations cannot be processed without payment. Please charge my Credit Card.
Name on Card *
Credit Card Type *
Card Number *
(please do not use spaces)		Expiration Date *

Comments

Release & Waiver Form
Please be informed that all NON MEMBER/SUBSCRIBERS registering for JCCGV programs will be charged an annual fee of $18 + HST
I, ( the Parent/Guardian of) the participant, agree by submitting this form, to give the JCCGV staff permission to act on my behalf in case of emergency and for the physician in attendance to hospitalize and secure proper treatment that may be needed for the person (s) registered above. Participation in aquatics, sports, dance and/or any other recreational activity can result in physical injuries. The person (s) registered above may participate in all the activities associated with the course (s) registered for and understands and freely assumes all such risks, both known and unknown, and assumes full responsibility for participation in these activities. The person(s) registered above is participating in the JCCGV program upon the express agreement and understanding that they are waiving and releasing the JCCGV and its board members, employees, staff, contractors, agents, successors, and assigns (collectively referred to as the "JCCGV") from any and all claims, cost, liabilities, expense or judgments, including legal fees and court costs arising (herein, collectively "claims") that they have, or may have in the future, arising from the participation of the person(s) registered above in any JCCGV programs, or any illness or injury resulting from such participation. The undersigned and the person(s) registered above hereby further agree to indemnity and hold harmless the JCCGV from and against any and all such claims arising due to any cause whatsoever including negligence, breach of contract, breach of any statutory or other duty of care, on the part of the JCCGV. The undersigned and the person(s) registered above further agree to indemnify and hold harmless the JCCGV from any and all liability for any property damage or personal injury to any third party resulting from participation by the person(s) registered above in these activities. I understand that photos may be taken of the person(s) registered, and may be used for publicity: This agreement shall be binding upon my heirs, next of kin, executors, administrators, assignees, representatives, and guardians, in the event of my death or incapacitation.
I Agree *

Program Cancellation and Refund Policy
A) Program schedules, prices and content are subject to change without notice. The JCC reserves the right to cancel, adjust or alter programs dependent upon registration, availability of facilities/program locations and weather conditions. Such changes may include cancellation in which case a full or pro-rated refund of the fee will be made. B) You may withdraw from a course and receive a refund up to two weeks before starting date. There will be a 10% charge (of the program fee) for this service. (Minimum $10, unless otherwise specified) C) You may withdraw from a course during the two weeks prior to starting date.There will be a 20% charge (of the program fee) for this service. (Minimum $20, unless otherwise specified) D) No refunds are issued after the first class without medical documentation. There is a $12.00 charge for this service. E) Transfers between programs will be allowed subject to space and coordinator's approval. $10 service charge. F) Some programs have non-refundable deposits and fees. G) For Camp and Early Childhood Cancellation & Refund Policies, please refer to separate information sheets, upon applying for spaces for your children.