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Pickleball Clinic Registration Form

A Pickleball Clinic is being held April 28th at the Ripley-Huron Community Centre. There are only 8 spots available in either timeslot. 

Times:

1:30-2:30PM Beginner Clinic

2:45-3:45PM Intermediate Clinic

Fee: $10.00

 

Instructor is Bob Riehl, a Pickleball Ambassador for Pickleball Ontario.

Bob has tournament experience playing at the 4.0 level. 

 

Emergency Contact Information

Please provide information that can be used in case of an emergency. 

Physical Activity Readiness Questionnaire

As promoters of a healthy lifestyle, we're concerned about your well-being when participating in our programs. To help identify the type of activity, which is most suited to each individual, we are asking you to complete a PAR-Q as part of the program. This questionnaire is designed to identify individuals for whom an increased physical activity might be inappropriate or those who should seek medical attention prior to participating in the program. 

Please read carefully and answer "yes" or "no" to each question. 

If you answered "yes" to any of the questions above, please consult your physician before increasing your physical activity level. 

PHOTO AND VIDEO CONSENT AND RELEASE

By signing this form, you are consenting to the taking of photographs and/or video recordings of you by the Township of Huron-Kinloss for the purposes of marketing and promoting programs. You are assigning to the Township of Huron-Kinloss and waiving any rights you have related to any photographs and video recordings, and you are consenting to the use of such photographs and/or video recordings, in whole or in part, by the Township of Huron-Kinloss. I hereby agree to allow photographs and/or video recordings to be taken of me, whether posed or candid, while I am on Township of Huron-Kinloss property and/or participating in Township of Huron-Kinloss programs.

ASSUMPTION OF RISK AND INDEMNYFING RELEASE

While Township of Huron-Kinloss staff and volunteers will make every reasonable effort to minimize exposure to known risks associated with each Registrant’s participation in a Township of Huron-Kinloss program (“Program”), I hereby acknowledge that I and/or my child if I am registering on his/her behalf (collectively, the “Registrant”) may be required, depending on the nature of the program, to participate in various physical activities that may involve a risk of injury. In this regard, I hereby permit the Registrant to participate in the full range of Program activities. In consideration of the Registrants opportunity to participate in the Program, the receipt and sufficiency of which is hereby acknowledged, I hereby release and hold harmless the Township of Huron-Kinloss, its respective officers, directors, employees, volunteers and agents, and their respective successors and assigns from any and all liability for damages sustained in consequences of loss, injury or damage to the Registrant, and from all other actions, causes of action, claims, demands or damages of any kind with respect to death, injury, loss or damages to any person or property arising out of or connected with preparation for, or participation in, the Program.

DISCLAIMER

All programs are subject to change or cancellation due to low enrolment numbers, lack of volunteers or other unforeseen circumstances that are prohibitive to the operations of the program.

COVID-19

The registrant understands and agrees that the Township of Huron-Kinloss shall not be liable for any losses or damages incurred by any person using the facility or sports field for the event, including sickness or death that occurs as a result of the COVID-19 pandemic and the registrant agrees to release the Township of Huron-Kinloss from any liability in connection therewith and further agrees to indemnify and hold harmless the Township of Huron-Kinloss from any claim that may be made by anyone using the facility or sports field for the event, against the Township of Huron-Kinloss in connection therewith.

The registrant is responsible to ensure current COVID-19 protocols mandated by the Province of Ontario, Grey-Bruce Public Health Unit, or the Township of Huron-Kinloss are followed during the event. This may include, but not be limited to, use of masks, physical distancing, and enhanced hand sanitizing.

REGISTRATION AGREEMENT

By signing my name, I (or my legal guardian) acknowledge that I (or we) have carefully read and understand the terms and conditions of the registration agreement. 

Clear

Freedom of Information

In accordance with the Municipal Freedom of Information and Privacy Act, personal information is collected under the authority of the Municipal Act, 2001 and will only be used for the purpose of pickleball registration. Questions about the collection of the personal information may be addressed to the Clerk at the Township of Huron-Kinloss, 21 Queen Street, P.O. Box 130, Ripley, ON, N0G 2R0 or (519) 395 3735.