Please contact if interested: briant44444@hotmail.com
ChamplainTable Tennis Club
NAME _____________________________________________________
Time: 8:30 to 4:30
Fee: Member $175/wk Non-Member $200/wk
Please circle:
Week 1 (June 30 to July 4) Week 2 (July 7 to July 11)
Week 3 (July 14 to July 18) Week 4 (July 21 to July 25)
Week 5 (July 28 to Aug 1) Week 6 (Aug 4 to Aug 8)
Week 7 (Aug 11 to Aug 15)
ps. exclude all holiday(s) and fee will be deduct
Please disclose any medical conditions which may affect participation (during and en route) of the sport:-________________________________________________________________
Liability/Permission waiver:
In case of injury or accident of any kind at the Champlain Table Tennis Club (CTTC) program, neither CTTC, nor OTTA, nor any employee nor volunteer at CTTC or OTTA, will be held liable for that occurrence. I hereby release CTTC and OTTA, its employees or volunteers from all claims or damage which may arise out of any loss or personal injury to any participants in this program. I hereby give CTTC permission to use any photographs/videos taken of me in this program for future promotional activities.
Member Signature ________________________________ Date _______________
parent/guardian for minors
Please make cheque payable to: Champlain Table Tennis Club
Notice of Changes or New Registration
ADDRESS ______________________________________________________________________
_______________________________________ POSTAL CODE _________________
email ____________________________________________________________________________
DATE OF BIRTH (DD/MM/YY) ____/_____/____ SEX (F/M)__________
(if minor)
NAME OF FATHER ________________________________ TEL (O)_________ TEL (H)_________
NAME OF MOTHER ________________________________ TEL (O)_________ TEL (H)_________
ChamplainTable Tennis Club
250 Anna Avenue, Ottawa, Ontario
Summer CampRegistration
NAME _____________________________________________________
Time: 8:30 to 4:30
Fee: Member $175/wk Non-Member $200/wk
Please circle:
Week 1 (June 30 to July 4) Week 2 (July 7 to July 11)
Week 3 (July 14 to July 18) Week 4 (July 21 to July 25)
Week 5 (July 28 to Aug 1) Week 6 (Aug 4 to Aug 8)
Week 7 (Aug 11 to Aug 15)
ps. exclude all holiday(s) and fee will be deduct
Please disclose any medical conditions which may affect participation (during and en route) of the sport:-________________________________________________________________
Liability/Permission waiver:
In case of injury or accident of any kind at the Champlain Table Tennis Club (CTTC) program, neither CTTC, nor OTTA, nor any employee nor volunteer at CTTC or OTTA, will be held liable for that occurrence. I hereby release CTTC and OTTA, its employees or volunteers from all claims or damage which may arise out of any loss or personal injury to any participants in this program. I hereby give CTTC permission to use any photographs/videos taken of me in this program for future promotional activities.
Member Signature ________________________________ Date _______________
parent/guardian for minors
Please make cheque payable to: Champlain Table Tennis Club
Notice of Changes or New Registration
ADDRESS ______________________________________________________________________
_______________________________________ POSTAL CODE _________________
email ____________________________________________________________________________
DATE OF BIRTH (DD/MM/YY) ____/_____/____ SEX (F/M)__________
(if minor)
NAME OF FATHER ________________________________ TEL (O)_________ TEL (H)_________
NAME OF MOTHER ________________________________ TEL (O)_________ TEL (H)_________
