Registration Form

New Or Returning Diver? *

Please select "Returning" if the diver has previously dived with or taken lessons with NODC.

New

Returning

Diver Name *

First Name

Last Name

Program Days

If the program requires multiple classes per week, please indicate the days you will attend.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday - 10:30am

Saturday - 11:30am

Sunday - 10:30am

Sunday - 11:30am

Program Session *

Fall (October-December)

Winter (Jan-March)

Spring (March-May)

Summer (June - July)

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone - Home

(###)

###

####

Emergency Contact Phone - Mobile *

(###)

###

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Medical Release Waiver *

I certify that I am the parent or legal guardian for my child(ren). I hereby give my permission for any supervisor, coach or other team administrator associated with the Nepean Ottawa Diving Club to seek and give appropriate medical attention for our child(ren) in the event of accident, injury, illness. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment. I hereby waive, release and forever discharge The Nepean Ottawa Diving Club from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in The Nepean Ottawa Diving Club activities, whether or not damages or loss is due to negligence. I hereby acknowledge that my children is (are) physically fit and capable of participation in all Dive Team activities.

I have read the above statement and indicate my agreement by checking the box.

Liability Waiver *

By registering my child(ren) with the Nepean Ottawa Diving Club, I agree to participate (or allow my child(ren) and family members to participate) in the Nepean Ottawa Diving Club, and hereby release The Nepean Ottawa Diving Club their officers, directors, employees, and agents, its directors, officers, agents, coaches, and employees from liability for any injury that might occur to myself (or to my child(ren) and family members) while participating in the Nepean Ottawa Diving Club program, including travel to and from training sessions, swim meets or other scheduled team activities. I agree to indemnify and hold harmless the above mentioned organizations and/or individuals, their agents and/or employees, against any and all liability for personal injury, including injuries resulting in death to me, my child(ren) and/or other family members, or damage to my property, the property to my child(ren) and/or other family members, or both, while I (or my child(ren) or family members) participating in the Nepean Ottawa Diving Club program.

I have read the above statement and indicate my agreement by checking the box.

Your Contact Information *

First Name

Last Name

Your Phone Number *

(###)

###

####

Your Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Method Of Payment *

Cheque

eTransfer to ottawadiving@rogers.com