Membership – Chilliwack & District Seniors' Resources Society

BECOME A MEMBER

Membership and Waiver Form

A signed Membership Form and Waiver is a requirement of our Risk Management Advisors and Insurer for each Chilliwack & District Seniors’ Resources Society (CDSRS) member participating in our Bus Trips and Activities. This form will be stored as part of our membership records and will be considered confidential.

Preferred First Name:

Full Legal Name:

Street Address:

City:

Postal Code:

Home Phone #:

Cell Phone #:

Email Address:

Birth Date:

Emergency Contact Name & Ph #

WAIVER:
From time to time, we would like to take photos of members to share on our website, in our office, in local advertising or on our Facebook page. Please acknowledge permission to share photos publicly:

Yes No Initials

Members who participate in our Activities and Bus Trips do so entirely at their own risk and will not hold the CDSRS, their staff and volunteer workers responsible for injury, loss or damage occurring during any Activity or Bus Trip. Participants agree to release, discharge, and undertake not to commence any action against the CDSRS from any and all claims and causes of action, or liability of any kind whatsoever for injuries, property damage, or death, which in any way results from participating in the Activities or Bus Trips. The CDSRS does not assume responsibility for loss of wages, medical, dental or hospital care for members or volunteers during the activities and Bus Trips.The CDSRS does guarantee that a current ICBC policy is in place with the recommended $10,000,000.00 liability.

If you attend a bus excursion outside of BC, you will be required to provide us with proof of travel/medical insurance.

Yes No Initials

The following information is collected for Activity or Bus Trip Participants and is to be used in the case of an Emergency only. This information will not be shared except with First Responders.

Drug Allergies or Medical Conditions:

I have read, understood, and agree to all of the above.

Signature: