Breast Cancer Action Ottawa
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Class Registration

Name(Required)
Test Payment
Email(Required)
Mailing Address(Required)

Emergency Contact Information

Name(Required)

Participant Waiver
I understand that my participation in these classes is voluntary and at my own risk. I take responsibility for any activity I elect to participate in. I acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries including death, damages or loss regardless of severity which I may sustain as a result of participating in any and all activities connected with/associated with these classes. I agree to waive and relinquish all claims I may have as a result of participating in the program against Breast Cancer Action and all officers, agents, servants, employees and/or against the instructor or substitute teacher. I understand that any photography taken while participating in a class or related event may be used for promotional purposes by Breast Cancer Action. In the event of emergency, I authorize Breast Cancer Action and the instructor to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my immediate care. I have carefully read, fully understand and agree to the aforementioned. Further, to the best of my knowledge, the health information provided above is accurate. Personal information will be kept secure and confidential.

Class Selection

Date of the WeekTimeClass NameVenueFormatInstructorStart and End Dates
Monday5:00-6:00 pmStretch and StrengthLink ProvidedZOOMKim BoudreauMonday, January 16-December 18
Tuesday1:00-2:00 pmTeena's Book ClubTBCHybrid zoom/in PersonMarie-Louise DoyleTuesday, January 17-December 19
Wednesday5:00-6:00 pmRestorative YogaLink ProvidedZOOMKim BoudreauWednesday, January 18-December 20
Wednesday1:00-3:00Art ExpressionTBCIn personPolly ErskineWednesday, January 18-December 20
Friday9:30-10:30Nia Fitness Wellness LifestyleLink ProvidedZOOMBarbara CarriereFriday, January 20-December 22
Class Selection(Required)
NOTE: There is a "Select All" button at the bottom of the dates
Stretch and Strength(Required)
Teena's Book Club(Required)
Restorative Yoga(Required)
Art Expression(Required)
Nia Fitness Wellness Lifestyle(Required)
Method of Payment
Note: Your class registration is only valid once we receive your payment.

After submitting this form, send a cheque to Breast Cancer Action, with the following address:

1130 St Emmanuel Terrace
Ottawa, Ontario
K1C 2J7

After submitting this form, send your eTransfer to : ed.bca@bcaott.ca

Password: "fitness"

Please have your credit card ready after submitting this form, and phone 613-736-5921

Please make sure to read and agree to the waiver above View and sign waiver above

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