Online Membership for Adult (18+)

Membership Form

First Name *
Last Name *
Street Address *
City *
Province *
Postal Code *
Membership Type *
NOTE that the ASRAB membership is annual, and is valid January 1 – December 31 each year. Members must re-apply annually.Individual - $15Family - $30Volunteer - no fee
Primary Phone *
Other Phone
Email *
Date of Birth: Month *
Date of Birth: Day *
Date of Birth: Year *
Medical Condition / Allergies
Are you visually impaired? *
YesNo
If Visually Impaired - Condition?

Emergency Contacts (Please list 2 if possible)

Contact 1 Name *
Contact 1 Relationship *
Contact 1 emergency phone number *
Contact 1 other phone
Contact 2 Name
Contact 2 Relationship
Contact 2 emergency phone number
Contact 2 other phone

Involvement with ASRAB

Please check if you are an athlete.
Athlete
Please list sports
Please check if you are a volunteer.
Volunteer
Please list events
Please check if you are a coach.
Coach
Please list level / sports

Consent and Agreement of Terms

CONSENT FOR USE OF PERSONAL INFORMATION AND PHOTO RELEASE 1. I understand and agree that as a member of the Alberta Sports and Recreation Association for the Blind (ASRAB) my personal information will be shared with the Canadian Blind Sports Association (CBSA) but that personal information will not be shared with other organizations without my written permission. I further agree that my personal information will be used for the purpose of receiving communications from ASRAB and for other purposes as described in ASRAB’s Privacy Policy.

2. Furthermore, I grant permission to ASRAB to photograph and/or record my image and/or voice on still or motion picture film and/or audio tape, and to use this material to promote ASRAB through the media of newsletters, websites, television, film, radio, print and/or display form. I understand that I waive any claim to remuneration for use of audio/visual materials used for these purposes.

3. I understand that I may withdraw such consent at any time by contacting ASRAB’s Privacy Officer. The Privacy Officer will advise the implications of such withdrawal. This consent is obtained in accordance with the Personal Information Protection and Electronic Documents Act and the Canadian Anti-Spam Legislation.

*We do not sell or distribute your personal information to any other third party not listed herein.*
By checking here, the Parties are consenting to the use of their electronic signatures in lieu of an original signature on paper and agree to the terms described in paragraphs 1 - 3. *
Electronic Signature Consent
MEDICAL CONSENT 4. I give permission to ASRAB to make decisions concerning emergency medical care and treatment, and where necessary to authorize such care and treatment, including but not limited to, injections, anesthesia or surgery.

5. I hereby give my permission to the licensed physician, dentist, athletic therapist, nurse or other medical professional whose services might be required to provide emergency medical care and treatment.
By checking here, the Parties are consenting to the use of their electronic signatures in lieu of an original signature on paper and agree to the terms described in paragraphs 4 - 5. *
Electronic Signature Consent
ACCEPTANCE OF TERMS AND CONDITIONS In consideration of the acceptance of my membership in ASRAB, I agree as follows:

6. To abide by the policies, rules and regulations of ASRAB.

7. To execute a Release of Liability, Waiver of Claims and Indemnity Agreement (if I am 18 years old or older) or to have my parent or guardian execute an Informed Consent and Assumption of Risk Agreement (if I am 17 years old or younger)

8. I have read, I understand and I accept the terms and conditions stated herein and I acknowledge that this agreement shall be effective and binding on me and my child/ward.
By checking here, the Parties are consenting to the use of their electronic signatures in lieu of an original signature on paper and agree to the terms described in paragraphs 6-8. *
Electronic Signature Consent
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT (FOR PARTICIPANTS 18 YEARS OF AGE AND OLDER)
WARNING! By signing this document you will waive certain legal rights, including the right to sue. Please read.

1. This is a binding legal agreement; therefore clarify any questions or concerns before signing. As a Participant participating in the programs, event and activities of the Alberta Sports and Recreation Association for the Blind (collectively the “Activities”), the undersigned acknowledges and agrees to the following terms:

Disclaimer
2. The Alberta Sports and Recreation Association for the Blind (ASRAB) and its directors, officers, members, employees, coaches, volunteers, officials, trainers, instructors, agents, and representatives (collectively the “Organization”) are not responsible for any injury, personal injury, damage, property damage, expense, loss of income or loss of any kind suffered by a Participant during, or as a result of, the Activities, caused in any manner whatsoever including, but not limited to, the negligence of the Organization.

Description of Risks
3. I am participating voluntarily in the Activities. In consideration of my participation, I hereby acknowledge that I am aware of the risks, dangers and hazards associated with or related to the Activities, including injuries which can be severe and even fatal. The risks, dangers and hazards include, but are not limited to, injuries from:
a) The hazards particular to the Activities in which I am participating
b) Executing strenuous and demanding physical techniques
c) Vigorous physical exertion, strenuous cardiovascular workouts and rapid movements
d) Exerting and stretching various muscle groups
e) Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment
f) Contact, colliding, falling or being struck by other participants or equipment
g) Failing to comply with the rules established for participation
h) Bad weather conditions including hypothermia, sunstroke, or dehydration
i) Failing to remain within designated areas and supervised activities
j) Travel to and from Events which are an integral part of the Activities

Release of Liability and Disclaimer
4. In consideration of the Organization allowing me to participate, I agree:
a) That my physical condition has been verified by a medical doctor to participate;
b) To remove myself if I sense or observe any unusual hazard or unsafe condition; or feel unable or unfit to safely continue;
c) To ASSUME all risks arising out of, associated with or related to my participation;
d) To WAIVE any and all claims that I may have now or in the future against the Organization;
e) To freely ACCEPT AND FULLY ASSUME all such risks and possibility of personal injury, death, property damage, expense and related loss, including loss of income, resulting from my participation in the activities, events and programs of the Organization; and
f) To FOREVER RELEASE the Organization from any and all liability for any and all claims, demands, actions, damages (including direct, indirect, special and/or consequential), losses, actions, judgments, and costs (including legal fees) (collectively, the “Claims”) which I may have or may in the future, that might arise out of, result from, or relate to my participation in the Activities, even though such Claims may have been caused by any manner whatsoever, including but not limited to, the negligence, gross negligence, negligent rescue, omissions, carelessness, breach of contract and/or breach of any statutory duty of care of the Organization.

Acknowledgement
5. I acknowledge that I have read and understand this agreement, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, spouse, children, parents, guardians, next of kin, executors, administrators and legal or personal representatives.

By typing in your name below and clicking the “I Agree” icon, you agree to be bound by this Legal Agreement.
Printed Name of Participant *
Agreement *
I AGREE

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Online Membership for Adult (18+)

Membership Form

Emergency Contacts (Please list 2 if possible)

Involvement with ASRAB

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