Adult Swim Lessons (January- February 2025) 8 classes

*Note: You must have paid and recorded a receipt number in-person to be registered.

Please choose a time slot Tuesdays:

Please choose a time slot Tuesdays: 4:15-4:55pm
Receipt Number
(This event has a fee please call 250-505-1325 or see the front desk for payment)
Name Name First Last
Phone Phone - ### - ### ####
Email
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Birth Date Birth Date / MM / DD YYYY
Gender:

Gender: Female Male Other Rather not to say. None
Student Number
Emergency Contact Emergency Contact First Last
Emergency Contact Phone Emergency Contact Phone - ### - ### ####
List any medical conditions/allergies if applicable. (Ex: diabetes, asthma, allergic to wasp sting).
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AGREEMENT REGARDING:
[name of event above] (the “Event”) TO: Selkirk College and its governors, officers, employees, students and representatives, independent contractors, suppliers, sponsors, heirs, executors, successors and assigns (all of whom are hereinafter referred as the “Releasees”). In this Agreement, the term "Event” shall include all activities or services provided, arranged, organized, conducted, sponsored or authorized by the Releasees and shall include, but is not limited to: all aspects of trip and activity discussed with Campus Rec Staff and other such activities, events and services in any way connected with or related thereto including the use and occupation of any facilities owned, leased, or licensed by the Releasees. ASSUMPTION OF RISKS I am aware that the Event involves risks, dangers and hazards including, but not limited to: mechanical failures of equipment, loss of balance; difficulty or inability to control one’s speed and direction; variation or steepness in terrain; rapid or uncontrolled acceleration on hills and inclines; variation in the terrain that may create blind spots or areas of reduced visibility; variation or changes in the surface including rocks, gravel and man-made structures; changing weather conditions; exposure to temperature extremes or inclement weather; travel or transport to and from the sites used for the Event; collision with other persons or vehicles; the failure of others to act safely or within their ability; becoming lost or separated; negligence of other persons; and NEGLIGENCE ON THE PART OF THE RELEASEES, INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF THE EVENT. I AM AWARE OF THE RISKS, DANGERS AND HAZARDS ASSOCIATED THE EVENT AND I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS, KNOWN AND UNKNOWN, AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM. I understand that all applicable rules for participation must be followed and that SOLE RESPONSIBILITY FOR MY PERSONAL SAFETY REMAINS WITH ME, including my physical and emotional preparation and fitness to participate in the Event. I will examine and inspect the conditions in which I participate and I undertake and agree to remove myself from participation if I sense or observe any unusual hazard or unsafe condition, or if, at any time, at any event or program, I feel unable or unfit to safely continue for any reason. RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT I have read the guidelines, rules and regulations issued for the Event, which I understand and I agree to by bound by them. In consideration of the Releasees allowing me to participate in the Event, and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I hereby agree as follows: 2. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES for any and all liability for any property damage, loss or personal injury to any third party resulting from my participation in the Event; 3. This Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity; 4. This Agreement and any rights, duties and obligations as between the parties to this Agreement shall be governed by and interpreted solely in accordance with the laws of the Province of British Columbia. This Agreement shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. This Agreement may only be modified in a writing signed by parties. If any of the terms of this Agreement are found by a court of competent jurisdiction to be unenforceable or invalid, the remaining terms shall not be affected. Section headings are for convenience only; and 5. Any litigation involving the parties to this Agreement shall be brought solely within the Province of British Columbia and shall be within the exclusive jurisdiction of the Courts of that province. In entering into this Agreement, I am not relying on any oral or written representations or statements made by the Releasees with respect to the safety of participating in the Event, other than what is set forth in this Agreement. I understand and agree that my participation in the Event is conditional upon my execution of this Agreement and waiver of my right to sue for any injury, loss or damage as described herein. Participation in the Event is subject to the discretion of the Releasees and is revocable. I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT PRIOR TO SIGNING IT, AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS THAT I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES INCLUDING THE RIGHT TO SUE.
Participant Signature. Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Parent/Guardian Signature (if under 19 years of age). Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.