Georgian Nordic Racing Team REGISTRATION FORM 09/10
Make cheque payable to G.N.S.C.C.
Our training and events calendar is regularly updated.
Name: _________________________________Age: ____
Club Member?: Y/N (Membership with Georgian Nordic is required and is not included in fee)
Address: ___________________________________________________
Town: _____________________________________________________
Postal Code: _________________
Phone: _______________(res.) ________________(work)
Email__________________________
Skype__________________________
Equipment you now have, circle one for each
| Skate Skis | Yes/No | Roller skis | Skate/Combi |
| Classic Skis | Yes/No | Classic roller skis | Yes/No |
| Bindings | NNN/Salomon | Pole tips for roller skis | Yes/No |
| Skating Poles | Yes/No | You wax your own skis | Yes/No |
| Classic Poles | Yes/No | Bottle holder for Waterbottle | Yes/No |
| Shades | Yes/No | Heart rate monitor | Yes/No |
This Waiver must be signed and dated when registering! I HEREBY AGREE to abide by the rules and Regulations of Cross Country Canada (hereinafter called the CCC), Southern Division (hereinafter called Division) and to participated in the events, activities, and programs sanctioned by CCC and Division in accordance with the Associations Rules, Regulations and by-laws. IN CONSIDERATION OF CCC, Division, and the Georgian Nordic Ski and Canoe Club Inc., acceptance of me as a registered member of the Association and by being permitted to take part in the Associations events, activities and programs, I hereby, for myself, my heirs, executors, administrators and assigns, forever release, discharge and hold harmless CCC, Division, Georgian Nordic Ski and Canoe Club Inc., its directors, officers, employees, representatives or agents and all land owners on the trail system.
Athlete Signature: ____________________________________________
Date: _______________
Parent or Guardian Name:____________________________________________
Parent or Guardian Signature__________________________________________
Health: Please indicate below if there is any particular condition the coach should be informed of (eg: peanut allergy, special needs, medical condition, etc.)
___________________________________________________________
Peter Wiltmann
GNSCC Head Coach
NCCP Level 3
Georgian Nordic Ski Team
Wawanaisa Road 33
Nobel, Ontario
P0G 1G0
705.342.9397
