This Registration Form is for Women's Only Training Nights (Winter 2018).
Marni will be coaching the team this year.
Training nights will be continuing on Mondays at the Richmond Olympic Oval.
Jan 15, 22, 29
Feb 12, 19, 26
Mar 12, 29, 26
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 for these 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 concerns?

Anything we should know in case of emergency? Any allergy?
 
{{answer_Mhyo1IHteCkv}}, 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.

 
You have answered no to being a member for the 2017-18 season. Please go to this link and register to continue. 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. *

 
This program will be $60 which includes 9 nights of training *

If you cannot pay the fee, please connect with Marni (Marni@bcwbs.ca)

 
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_Mhyo1IHteCkv}}, please have your parent/guardian read and agree to this term for you.

Parent or Guardian of  {{answer_Mhyo1IHteCkv}}, please accept the term for  {{answer_Mhyo1IHteCkv}}. *

I do hereby, on behalf of  {{answer_Mhyo1IHteCkv}} {{answer_dxnQhiFgwodc}} , 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_Mhyo1IHteCkv}}  {{answer_dxnQhiFgwodc}} 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_Mhyo1IHteCkv}} {{answer_dxnQhiFgwodc}} '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 in the new year.
For questions, please contact Marni at 604-333-3532 or Marni@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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