This Registration Form is for
the BCWBS - Bridging the Gap (BTG) Game Nights Summer 2017.
If you have never played wheelchair basketball before, except at Have-a-Go type of events, please fill out "the registration form for new participants" (not this form) or contact BCWBS (604-333-3532/nadine@bcwbs.ca). You must be a paid member to attend these nights, so please make fill out the appropriate information. 
If you are under 19 years old, you must have your parent/guardian read and understand the terms in the registration form with you, and have him/her accept the terms on behalf of you.
 
Are you under 19 years old as of today? *

     
 
What is your first name?

 
What is your last name? *

 
What is the name of your parent/guardian? *

 
What is your mailing address? *

Please include City and Postal Code.
 
What is your phone number that we can reach you at? *

Please include area code.
 
Is this number for... *


 
Please tell us another phone number that we can reach you at, if possible.

 
Is this number for...


 
What is your date of birth? *

 
What gender do you identify as? *

 
Do you need to borrow a sport wheelchair at the league? *

     
 
What type of wheelchair would you need? *

Please note that we may not find you a perfect wheelchair but we'll try our best!

 
Do you have any medical concern?

Anything we should know in case of emergency? Any allergy?
 
{{answer_j4sB}}, have you become a 2016-17 season BCWBS individual member yet?

To become a member for the 2016-17 season, you need to complete a membership form and pay $35 membership (or $20 if uner 19) to BCWBS. The membership term is Sept 1 - Aug 31 each season.
Please contact BCWBS at 604-333-3530 or info@bcwbs.ca if you are not sure.

 
Please select the membership you would like to pay for: *


 
Do you have a disability?


 
Please specify name of the disability, level of injury, and on-set date/year. *

 
Do you have an injury that prevents you from playing competitive sports permanently?


 
What is your permanent injury/impairment? *

 
Please read and agree to
the BC Wheelchair Basketball Society Athlete Agreement &  Code of Conduct: *

1.0   All athletes are ambassadors of BC Wheelchair Basketball and shall maintain high standards of moral and ethical conduct which includes self control and responsible behaviour, and consideration for others’ physical and emotional well-being.
2.0   Athletes shall treat others with respect and expect to be treated with respect in return.
3.0   Athletes must uphold the standards of Fairplay, and exhibit a high level of sportsmanship and team spirit.
4.0   Athletes shall refrain from the use of profane, insulting, harassing or otherwise offensive language.
5.0   Athletes shall abide by the Policies and Procedures of the BC Wheelchair Basketball Society and the BC Wheelchair Sports Association where applicable.  
6.0   Athletes in attendance at Wheelchair Basketball Canada events shall adhere to the Wheelchair Basketball Canada Code of Conduct and Ethics (www.wheelchairbasketball.ca in the Resources / Policies section)
7.0   Athletes shall dress in the appropriate attire at all times, as directed by the Team Coach or Manager.  All athletes shall maintain high personal hygiene standards.
8.0   Any team members attending National competitions are required to stay in designated accommodation.  Visitors will not be permitted to share these accommodations.
9.0   All athletes are required to abide by curfew set by management staff and/or host organizing committee.
10.0   Any athlete committing an act which is considered an offense under the law will be dealt with by the appropriate authorities.
11.0   All athletes shall agree that:
     11.1      They shall not possess or use any illegal drugs, excluding prescribed medical drugs which shall be registered with the appropriate official prior to the event.  The use of performance enhancing drugs is strictly prohibited.
     11.2      Athletes under the age of 19 will not possess or use alcohol or tobacco in any form during the event or at any social activities connected with the event.
     11.3      Athletes 19 years and over will not possess or use alcohol in any form within the immediate area of an event, or competition site, and not in excess in the residence.  Athletes will not supply alcohol to minors.
     11.4      Tobacco smoking for athletes over the age of 19 is strongly discouraged, and will only be allowed in designated smoking areas.
     11.5      Any willful damage to hotel rooms or other property shall be assessed to the account of the athlete(s) involved.
     11.6      All athletes must recognize that the Team Coaching Staff is responsible for the team and its actions, and they must adhere to guidelines set down by the Team Coaching Staff.  

A breach of any part of this code of conduct is sufficient grounds for a member to be withdrawn from an event and to be sent home at his/her own expense, and/or removal from the competition, future competitions, and financial assistance including AAP.  Athletes are subject to the disciplinary policies and procedures of the BC Wheelchair Sports Association as presented in the association’s Policy & Procedures Manual.

I have read and understand the above statements and agree to conduct myself in a manner that demonstrates the standards established in the Athlete Agreement and Code of Conduct by accepting the terms.  
     
 
Please read the BC Wheelchair Basketball Society Athlete Agreement &  Code of Conduct with your parent or guardian and have him/her accept the terms on behalf of you if you agree to the terms.

Parent or Guardian of {{answer_j4sB}}, please accept the terms on behalf of {{answer_j4sB}} {{answer_sAXW}}: *

1.0   All athletes are ambassadors of BC Wheelchair Basketball and shall maintain high standards of moral and ethical conduct which includes self control and responsible behaviour, and consideration for others’ physical and emotional well-being.
2.0   Athletes shall treat others with respect and expect to be treated with respect in return.
3.0   Athletes must uphold the standards of Fairplay, and exhibit a high level of sportsmanship and team spirit.
4.0   Athletes shall refrain from the use of profane, insulting, harassing or otherwise offensive language.
5.0   Athletes shall abide by the Policies and Procedures of the BC Wheelchair Basketball Society and the BC Wheelchair Sports Association where applicable.  
6.0   Athletes in attendance at Wheelchair Basketball Canada events shall adhere to the Wheelchair Basketball Canada Code of Conduct and Ethics (www.wheelchairbasketball.ca in the Resources / Policies section)
7.0   Athletes shall dress in the appropriate attire at all times, as directed by the Team Coach or Manager.  All athletes shall maintain high personal hygiene standards.
8.0   Any team members attending National competitions are required to stay in designated accommodation.  Visitors will not be permitted to share these accommodations.
9.0   All athletes are required to abide by curfew set by management staff and/or host organizing committee.
10.0   Any athlete committing an act which is considered an offense under the law will be dealt with by the appropriate authorities.
11.0   All athletes shall agree that:
     11.1      They shall not possess or use any illegal drugs, excluding prescribed medical drugs which shall be registered with the appropriate official prior to the event.  The use of performance enhancing drugs is strictly prohibited.
     11.2      Athletes under the age of 19 will not possess or use alcohol or tobacco in any form during the event or at any social activities connected with the event.
     11.3      Athletes 19 years and over will not possess or use alcohol in any form within the immediate area of an event, or competition site, and not in excess in the residence.  Athletes will not supply alcohol to minors.
     11.4      Tobacco smoking for athletes over the age of 19 is strongly discouraged, and will only be allowed in designated smoking areas.
     11.5      Any willful damage to hotel rooms or other property shall be assessed to the account of the athlete(s) involved.
     11.6      All athletes must recognize that the Team Coaching Staff is responsible for the team and its actions, and they must adhere to guidelines set down by the Team Coaching Staff.  

A breach of any part of this code of conduct is sufficient grounds for a member to be withdrawn from an event and to be sent home at his/her own expense, and/or removal from the competition, future competitions, and financial assistance including AAP.  Athletes are subject to the disciplinary policies and procedures of the BC Wheelchair Sports Association as presented in the association’s Policy & Procedures Manual.

I, a parent/guardian of {{answer_j4sB}}  {{answer_sAXW}},  have read the above statements with {{answer_j4sB}} {{answer_sAXW}}, and I and {{answer_j4sB}} {{answer_sAXW}} understand and agree that the above named child conducts himself/herself in a manner that demonstrates the standards established in the Athlete Agreement and Code of Conduct by accepting the terms.  
     
 
Please select the items that you would like to register for: *

Please select the full package ($10 discount) or night(s) that you wish to attend.

 
Please read the consent and waiver below carefully and accept the term to register. *

I, on behalf of myself, members of my family, my heirs, executors, administrators and assigns, consent to and assume all risks and hazards of and incidental to my participation in the activities of the BC Wheelchair Basketball Society (BCWBS) and forever release, discharge and hold harmless BCWBS and all other parties, including agents, other associations and sponsoring companies, connected with BCWBS programs and events for any injury, loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in the BCWBS activities and notwithstanding that the same may have been contributed to or occasioned by the activities of BCWBS and all other parties, including agents, servants and volunteers of BCWBS, other associations and sponsoring companies. I also give full permission for use of my name and/or photograph/image in connection with BCWBS publications, website & other promotional materials.
     
 
{{answer_j4sB}}, please have your parent/guardian read and agree to this term for you.

Parent or Guardian of  {{answer_j4sB}}, please accept the term for  {{answer_j4sB}}. *

I do hereby, on behalf of  {{answer_j4sB}} {{answer_sAXW}} , myself, members of his/her family, his/her heirs, executors, administrators and assigns, consent to and assume all risks and hazards of and incidental to participation of {{answer_j4sB}}  {{answer_sAXW}} in the activities of the BC Wheelchair Basketball Society (BCWBS) and forever release, discharge and hold harmless BCWBS and all other parties, including agents, other associations and sponsoring companies, connected with BCWBS programs and events for any injury, loss or damage to the above-named boy or girl, or his/her property howsoever caused, arising out of or in connection with his/her taking part in the BCWBS activities and notwithstanding that the same may have been contributed to or occasioned by the activities of BCWBS and all other parties, including agents, servants and volunteers of BCWBS, other associations and sponsoring companies. I also give full permission for use of {{answer_j4sB}} {{answer_sAXW}} 's name and/or photograph/image in connection with BCWBS publications, website & other promotional materials.
     
 
Your total fee is {{var_price}}. Please fill in your payment information below.

 
Please enter your Credit or Debit Card number:

 
The CVC number:

(3 or 4 digit security number on the back of your card)
 
The name on your card:

 
Your card's expiry month:


 
Your card's expiry year:


Thank you for your registration.  
We will send you more detailed information closer to the date. 
For questions, please contact BCWBS at 604-333-3531 or programs@bcwbs.ca
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