This Registration Form is for
the BCWBS - Bridging the Gap (BTG) Game Nights Fall 2017 for first time players. 
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.
start
 
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 with?

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

     
 
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_VT68TlC4BmRh}}, have you become a 2017-18 season BCWBS individual member yet?

To become a member for the 2017-18 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. If you would like to attend other events with BCWBS you will need to become and member and can do so at this link here: https://bcwbs.typeform.com/to/Xl7vra

 
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 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_VT68TlC4BmRh}}, please have your parent/guardian read and agree to this term for you.

Parent or Guardian of  {{answer_VT68TlC4BmRh}}, please accept the term for  {{answer_VT68TlC4BmRh}}. *

I do hereby, on behalf of  {{answer_VT68TlC4BmRh}} {{answer_yATu6pYemsbU}} , 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_VT68TlC4BmRh}}  {{answer_yATu6pYemsbU}} 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_VT68TlC4BmRh}} {{answer_yATu6pYemsbU}} 's name and/or photograph/image in connection with BCWBS publications, website & other promotional materials.
     
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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Please register for your 2017-18 season membership here: https://bcwbs.typeform.com/to/Xl7vra
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