Membership Registration


Pickleball Mississauga Association (PMA)

Affiliated with the City of Mississauga Recreation and Parks Division

            Member of the Mississauga Sports Council, Member of Mississauga Senior Council


                        Email: pickleball.mississauga@yahoo.ca Website: pickleballmississauga.com


                                                            Membership Registration


Name: (Mr / Mrs / Ms) _____________________________________________ M / F (circle)



Address: ____________________________________________________________________


City ____________________________ Postal Code _____________ Year of Birth _________


Email ___________________________________________ Phone _____________________



Health Declaration


I consider myself physically able to participate in Pickleball and will assume all risks associated with playing Pickleball.  My doctor has recommended such physical activity.


Medical Authorization


I accept responsibility for my own medical coverage. I give permission to staff and volunteers with the City of Mississauga or PMA to arrange for any emergency care including hospitalization and transportation if necessary, and I agree to pay for all expenses and costs incurred thereby. 


Waiver of Liability


I release and waive all claims and hold harmless PMA, the Corporation of the City of Mississauga, as well as any venue where PMA might play, including their elected officials, officers, employees, agents, representatives, volunteers and any other participants, for any liability, property damage or personal injury resulting to me.


Disclosure Statement


I agree my personal information limited to email address and telephone number can be shared within the PMA and its members without my prior consent. Any other personal information must remain confidential for use by PMA only and for its intended use.


Would you like to become a volunteer?   Yes ______  No ______ 


I have read and understood the health declaration, medical authorization, waiver of liability and disclosure statement as listed above.



Signature: ____________________________________________________________

 


Date: _____________________

 

 

 

Annual Membership Fee: $5.00


Valid until August 31, 20


PAID: $_________


PMA-membership-form (2017-09)

 

 


 


 







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Rene St. Cyr,
Sep 14, 2017, 6:42 PM