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Get Directions
519-627-6224
Home
Activities & Programs
Current Schedule
Fitness Activities
Creative Endeavours
Games
Health & Wellness
Who We Are
About Our Activity Centre
Vision & Mission Statement
Staff & Board Members
Meet Our Instructors
Photo Gallery
Get Involved
Registration Information
Volunteer
Join Our Board
Register For Website Updates
Useful Resources
Make A Donation
News & Events
Our Events
Latest News
Activity Blog
Exercise
Recipes
Crafts
Nature
Trivia
Humour
Virtual Tours
Contact
Registration Form
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Registration Form
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Page Content
Annual Membership Fee
$45 (Jan 1-Dec 31)
If renewing before Dec 31: $40
Membership Number
Personal Information
Name
First
Last
Address
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
Email
(Required)
Home Phone
Mobile Phone
Birthday
MM slash DD slash YYYY
Safety Information
Allergies
Emergency Contact Name
First
Last
Emergency Contact Phone
Emergency Contact Relationship
Communication Preferences
I would like to receive emails about upcoming events at Wallaceburg Adult Activity Centre and related community information
I would like to have my birthday published in newsletter and on the 99.1 radio station.
Volunteer Opportunities
I would be interested in serving on the Board of Directors in the future.
I am interested in volunteering at the WAAC.
I would like to help out in the following ways:
Greeter
Program Assistance
Office Assistance
Website
Off-site Bingo
Other
Other
Interests
Please select all programs/activities that are of interest to you
Cards
Pool (Billiards)
Crafts
Fitness Equipment
Fitness Classes
Wii Games
Trips
Dining
Education
Socializing
Bingo/Trivia/Karaoke
Other
Demographic Information (Optional)
The information in this section is completely optional and will only be used to assist the WAAC in program development and grant applications and/or reporting. Your personal details will not be shared
Age Range
45-54
55-64
65-74
75-84
85+
Do you identify as any of the following under-represented groups:
Indigenous
Francophone
LGBTQ+
Other
Other
Waiver
Wallaceburg Adult Activity Club has the right to refuse membership to any individual or group. Members must remain in good standing; meaning adherence to the behavior standards set out by the Centre’s Code of Conduct Policy (#2-2) and all other Centre policies. Disciplinary actions will proceed as outlined in the Policy
I and anyone claiming on my behalf release and forever discharge Wallaceburg Senior Citizens Club Inc. (also known as the Wallaceburg Adult Activity Club), and its affiliates, successors and assigns, officers, employees, volunteers, representatives, partners, agents and anyone claiming through them (collectively, the Centre), in their individual and/or corporate capacities from causes of action of any nature and kind, known or unknown, which I may have against the Centre or any Released Parties arising out of or relating to any injury, loss or damage to person and property that may be sustained as a result of participation in the Activity (“Claims”).
I understand that participation in programs and activities involves inherent risks, including risk of physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent paralysis and/or death, and I assume all related risks and voluntarily participate in these programs and activities.
I agree to indemnify the Centre against any and all claims, actions, lawsuits, damages and judgments, including attorney’s fees, arising out of or relating to my participation in the Activity.
This Release for Participation in Event or Activity (“Release”) shall not be in any way construed as an admission by the Centre that it has acted wrongfully with respect to me or any other person, that it admits liability or responsibility at any time for any purpose, or that I have any rights whatsoever against the Centre.
I agree to comply with all COVID-19 protocols as set by the Centre, including but not limited to social distancing, sanitization, masking, and vaccination. I agree to not attend the Centre or any Centre hosted program or activity if I am experiencing any symptoms of COVID-19. I also release the Centre from any responsibility in the event that I contract COVID-19 at any Centre-sponsored activity.
Signature
Email
This field is for validation purposes and should be left unchanged.
Visit the Wallaceburg Adult Activity Centre.
We are open Mon - Fri: 8:30am - 5:30pm
Call 519-627-6224
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