c/o 150 King St. W.

Box 76, Toronto, ON M5H 1J9

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Rebounders Canada is a registered Canadian charity offering support and social opportunities to adults who are living with the long-term effects of childhood cancer. This Membership Form must be filled out and signed to participate in Rebounders activities.

Some fields are optional.

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Name
Address
Date of Birth
Gender
Selected Value: 1960
I give permission to have the above information included in Rebounders Membership Directories.
I give permission for photos of myself to be included for purposes of Rebounders promotion and communications, including, but not limited to newsletters, website, brochures, videos and the Rebounders Facebook page.
I consent to receive information from Rebounders by email.
General consent
By completing this form I am indicating that I wish to participate in activities offered by Rebounders Canada. I understand that Rebounders Canada is a registered Canadian charity that provides support and social opportunities for adult survivors of childhood cancer. I further understand that Rebounders Canada activities may operate with limited or no supervision or with assistance that is provided by fellow survivors of childhood cancer. If I require personalized care for any reason, including those caused by physical, mental or emotional challenges, I understand that I am to make my own arrangements for this and notify Rebounders Canada group leaders in advance of events. I understand that Rebounders Canada accepts no responsibility for loss, damage or injury caused by, or during attendance of, any organized activity. As a participant in Rebounders Canada activities I promise to conduct myself in a manner that is mature, safe and respectful of fellow participants, supervisors/group leaders, supporters and host venue representatives.