Volunteer Registration Form

February 15-17, 2008

Personal Information

First name

Middle name

Family/last name

Address Line 2

Address

Postal code

City/Town

Province

Work phone

Home phone

E-Mail

T-Shirt Size

DOB

Emergency Contact Information

Name and phone number (relationship)

Health Information

Medical alert

Diet alert

Skills, preferences and availability

Specfic Skills

Skills

Committee

Availability

(please note each day and time you are available)

Job preferences

Job Title (if known):

Release form

In consideration of the Committee's acceptance of my registration, I intend to be legally responsible for myself, my heirs, executors, administrators,

and do hereby release and discharge the Championship Organizing Committee, the Town of Collingwood, Paralympics Ontario, Sport Alliance of Ontario,

OWSA, OBSA, OCPSA, OTA, OPA & their representatives, successors and assigns, from any and all liability, arising from illness, injuries and

damage that I may suffer as a result of my participation in this event, or transportation to and/or from event venues. I further attest that I am physically able

to partpcipate as a volunteer in said Championships and a medical doctor has verified my physical condition within the last 12 months, and I consent to any medical treatment.

I also give permission for the free use of my picture and/or name in any broadcast, telecast, or any other account of this event.

Signature date

(if over 18 leave blank, parent or guardian required if under 18)

Signer name