Class Registration Name(Required) First Last Test Payment Test Payment - Registration will not be valid Test Amount Price: Phone(Required)Email(Required) Enter Email Confirm Email Mailing Address(Required) Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Emergency Contact InformationName(Required) First Last Phone(Required)Email(Required) Participant WaiverI 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. I have read and agree to the terms above 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 ClassClass Selection(Required) Stretch and Strength - Monday Teena's Book Club - Tuesday Restorative Yoga - Wednesday Art Expression - Wednesday Nia Fitness Wellness Lifestyle - Friday NOTE: There is a "Select All" button at the bottom of the datesStretch and Strength(Required) Monday, January 16th, 2023 at 5:00pm Monday, January 23rd, 2023 at 5:00pm Monday, January 30th, 2023 at 5:00pm Monday, February 6th, 2023 at 5:00pm Monday, February 13th, 2023 at 5:00pm Monday, February 20th, 2023 at 5:00pm Monday, February 27th, 2023 at 5:00pm Monday, March 6th, 2023 at 5:00pm Monday, March 13th, 2023 at 5:00pm Monday, March 20th, 2023 at 5:00pm Monday, March 27th, 2023 at 5:00pm Monday, April 3rd, 2023 at 5:00pm Monday, April 10th, 2023 at 5:00pm Monday, April 17th, 2023 at 5:00pm Monday, April 24th, 2023 at 5:00pm Monday, May 1st, 2023 at 5:00pm Monday, May 8th, 2023 at 5:00pm Monday, May 15th, 2023 at 5:00pm Monday, May 22nd, 2023 at 5:00pm Monday, May 29th, 2023 at 5:00pm Monday, June 5th, 2023 at 5:00pm Monday, June 12th, 2023 at 5:00pm Monday, June 19th, 2023 at 5:00pm Monday, June 26th, 2023 at 5:00pm Monday, July 3rd, 2023 at 5:00pm Monday, July 10th, 2023 at 5:00pm Monday, July 17th, 2023 at 5:00pm Monday, July 24th, 2023 at 5:00pm Monday, July 31st, 2023 at 5:00pm Monday, August 7th, 2023 at 5:00pm Monday, August 14th, 2023 at 5:00pm Monday, August 21st, 2023 at 5:00pm Monday, August 28th, 2023 at 5:00pm Monday, September 4th, 2023 at 5:00pm Monday, September 11th, 2023 at 5:00pm Monday, September 18th, 2023 at 5:00pm Monday, September 25th, 2023 at 5:00pm Monday, October 2nd, 2023 at 5:00pm Monday, October 9th, 2023 at 5:00pm Monday, October 16th, 2023 at 5:00pm Monday, October 23rd, 2023 at 5:00pm Monday, October 30th, 2023 at 5:00pm Monday, November 6th, 2023 at 5:00pm Monday, November 13th, 2023 at 5:00pm Monday, November 20th, 2023 at 5:00pm Monday, November 27th, 2023 at 5:00pm Monday, December 4th, 2023 at 5:00pm Monday, December 11th, 2023 at 5:00pm Monday, December 18th, 2023 at 5:00pm Select AllTeena's Book Club(Required) Tuesday, January 17th, 2023 at 1:00pm Tuesday, January 24th, 2023 at 1:00pm Tuesday, January 31st, 2023 at 1:00pm Tuesday, February 7th, 2023 at 1:00pm Tuesday, February 14th, 2023 at 1:00pm Tuesday, February 21st, 2023 at 1:00pm Tuesday, February 28th, 2023 at 1:00pm Tuesday, March 7th, 2023 at 1:00pm Tuesday, March 14th, 2023 at 1:00pm Tuesday, March 21st, 2023 at 1:00pm Tuesday, March 28th, 2023 at 1:00pm Tuesday, April 4th, 2023 at 1:00pm Tuesday, April 11th, 2023 at 1:00pm Tuesday, April 18th, 2023 at 1:00pm Tuesday, April 25th, 2023 at 1:00pm Tuesday, May 2nd, 2023 at 1:00pm Tuesday, May 9th, 2023 at 1:00pm Tuesday, May 16th, 2023 at 1:00pm Tuesday, May 23rd, 2023 at 1:00pm Tuesday, May 30th, 2023 at 1:00pm Tuesday, June 6th, 2023 at 1:00pm Tuesday, June 13th, 2023 at 1:00pm Tuesday, June 20th, 2023 at 1:00pm Tuesday, June 27th, 2023 at 1:00pm Tuesday, July 4th, 2023 at 1:00pm Tuesday, July 11th, 2023 at 1:00pm Tuesday, July 18th, 2023 at 1:00pm Tuesday, July 25th, 2023 at 1:00pm Tuesday, August 1st, 2023 at 1:00pm Tuesday, August 8th, 2023 at 1:00pm Tuesday, August 15th, 2023 at 1:00pm Tuesday, August 22nd, 2023 at 1:00pm Tuesday, August 29th, 2023 at 1:00pm Tuesday, September 5th, 2023 at 1:00pm Tuesday, September 12th, 2023 at 1:00pm Tuesday, September 19th, 2023 at 1:00pm Tuesday, September 26th, 2023 at 1:00pm Tuesday, October 3rd, 2023 at 1:00pm Tuesday, October 10th, 2023 at 1:00pm Tuesday, October 17th, 2023 at 1:00pm Tuesday, October 24th, 2023 at 1:00pm Tuesday, October 31st, 2023 at 1:00pm Tuesday, November 7th, 2023 at 1:00pm Tuesday, November 14th, 2023 at 1:00pm Tuesday, November 21st, 2023 at 1:00pm Tuesday, November 28th, 2023 at 1:00pm Tuesday, December 5th, 2023 at 1:00pm Tuesday, December 12th, 2023 at 1:00pm Tuesday, December 19th, 2023 at 1:00pm Select AllRestorative Yoga(Required) Wednesday, January 18th, 2023 at 5:00pm Wednesday, January 25th, 2023 at 5:00pm Wednesday, February 1st, 2023 at 5:00pm Wednesday, February 8th, 2023 at 5:00pm Wednesday, February 15th, 2023 at 5:00pm Wednesday, February 22nd, 2023 at 5:00pm Wednesday, March 1st, 2023 at 5:00pm Wednesday, March 8th, 2023 at 5:00pm Wednesday, March 15th, 2023 at 5:00pm Wednesday, March 22nd, 2023 at 5:00pm Wednesday, March 29th, 2023 at 5:00pm Wednesday, April 5th, 2023 at 5:00pm Wednesday, April 12th, 2023 at 5:00pm Wednesday, April 19th, 2023 at 5:00pm Wednesday, April 26th, 2023 at 5:00pm Wednesday, May 3rd, 2023 at 5:00pm Wednesday, May 10th, 2023 at 5:00pm Wednesday, May 17th, 2023 at 5:00pm Wednesday, May 24th, 2023 at 5:00pm Wednesday, May 31st, 2023 at 5:00pm Wednesday, June 7th, 2023 at 5:00pm Wednesday, June 14th, 2023 at 5:00pm Wednesday, June 21st, 2023 at 5:00pm Wednesday, June 28th, 2023 at 5:00pm Wednesday, July 5th, 2023 at 5:00pm Wednesday, July 12th, 2023 at 5:00pm Wednesday, July 19th, 2023 at 5:00pm Wednesday, July 26th, 2023 at 5:00pm Wednesday, August 2nd, 2023 at 5:00pm Wednesday, August 9th, 2023 at 5:00pm Wednesday, August 16th, 2023 at 5:00pm Wednesday, August 23rd, 2023 at 5:00pm Wednesday, August 30th, 2023 at 5:00pm Wednesday, September 6th, 2023 at 5:00pm Wednesday, September 13th, 2023 at 5:00pm Wednesday, September 20th, 2023 at 5:00pm Wednesday, September 27th, 2023 at 5:00pm Wednesday, October 4th, 2023 at 5:00pm Wednesday, October 11th, 2023 at 5:00pm Wednesday, October 18th, 2023 at 5:00pm Wednesday, October 25th, 2023 at 5:00pm Wednesday, November 1st, 2023 at 5:00pm Wednesday, November 8th, 2023 at 5:00pm Wednesday, November 15th, 2023 at 5:00pm Wednesday, November 22nd, 2023 at 5:00pm Wednesday, November 29th, 2023 at 5:00pm Wednesday, December 6th, 2023 at 5:00pm Wednesday, December 13th, 2023 at 5:00pm Wednesday, December 20th, 2023 at 5:00pm Select AllArt Expression(Required) Wednesday, January 18th, 2023 at 1:00pm Wednesday, January 25th, 2023 at 1:00pm Wednesday, February 1st, 2023 at 1:00pm Wednesday, February 8th, 2023 at 1:00pm Wednesday, February 15th, 2023 at 1:00pm Wednesday, February 22nd, 2023 at 1:00pm Wednesday, March 1st, 2023 at 1:00pm Wednesday, March 8th, 2023 at 1:00pm Wednesday, March 15th, 2023 at 1:00pm Wednesday, March 22nd, 2023 at 1:00pm Wednesday, March 29th, 2023 at 1:00pm Wednesday, April 5th, 2023 at 1:00pm Wednesday, April 12th, 2023 at 1:00pm Wednesday, April 19th, 2023 at 1:00pm Wednesday, April 26th, 2023 at 1:00pm Wednesday, May 3rd, 2023 at 1:00pm Wednesday, May 10th, 2023 at 1:00pm Wednesday, May 17th, 2023 at 1:00pm Wednesday, May 24th, 2023 at 1:00pm Wednesday, May 31st, 2023 at 1:00pm Wednesday, June 7th, 2023 at 1:00pm Wednesday, June 14th, 2023 at 1:00pm Wednesday, June 21st, 2023 at 1:00pm Wednesday, June 28th, 2023 at 1:00pm Wednesday, July 5th, 2023 at 1:00pm Wednesday, July 12th, 2023 at 1:00pm Wednesday, July 19th, 2023 at 1:00pm Wednesday, July 26th, 2023 at 1:00pm Wednesday, August 2nd, 2023 at 1:00pm Wednesday, August 9th, 2023 at 1:00pm Wednesday, August 16th, 2023 at 1:00pm Wednesday, August 23rd, 2023 at 1:00pm Wednesday, August 30th, 2023 at 1:00pm Wednesday, September 6th, 2023 at 1:00pm Wednesday, September 13th, 2023 at 1:00pm Wednesday, September 20th, 2023 at 1:00pm Wednesday, September 27th, 2023 at 1:00pm Wednesday, October 4th, 2023 at 1:00pm Wednesday, October 11th, 2023 at 1:00pm Wednesday, October 18th, 2023 at 1:00pm Wednesday, October 25th, 2023 at 1:00pm Wednesday, November 1st, 2023 at 1:00pm Wednesday, November 8th, 2023 at 1:00pm Wednesday, November 15th, 2023 at 1:00pm Wednesday, November 22nd, 2023 at 1:00pm Wednesday, November 29th, 2023 at 1:00pm Wednesday, December 6th, 2023 at 1:00pm Wednesday, December 13th, 2023 at 1:00pm Wednesday, December 20th, 2023 at 1:00pm Select AllNia Fitness Wellness Lifestyle(Required) Friday, January 20th, 2023 at 9:30am Friday, January 27th, 2023 at 9:30am Friday, February 3rd, 2023 at 9:30am Friday, February 10th, 2023 at 9:30am Friday, February 17th, 2023 at 9:30am Friday, February 24th, 2023 at 9:30am Friday, March 3rd, 2023 at 9:30am Friday, March 10th, 2023 at 9:30am Friday, March 17th, 2023 at 9:30am Friday, March 24th, 2023 at 9:30am Friday, March 31st, 2023 at 9:30am Friday, April 7th, 2023 at 9:30am Friday, April 14th, 2023 at 9:30am Friday, April 21st, 2023 at 9:30am Friday, April 28th, 2023 at 9:30am Friday, May 5th, 2023 at 9:30am Friday, May 12th, 2023 at 9:30am Friday, May 19th, 2023 at 9:30am Friday, May 26th, 2023 at 9:30am Friday, June 2nd, 2023 at 9:30am Friday, June 9th, 2023 at 9:30am Friday, June 16th, 2023 at 9:30am Friday, June 23rd, 2023 at 9:30am Friday, June 30th, 2023 at 9:30am Friday, July 7th, 2023 at 9:30am Friday, July 14th, 2023 at 9:30am Friday, July 21st, 2023 at 9:30am Friday, July 28th, 2023 at 9:30am Friday, August 4th, 2023 at 9:30am Friday, August 11th, 2023 at 9:30am Friday, August 18th, 2023 at 9:30am Friday, August 25th, 2023 at 9:30am Friday, September 1st, 2023 at 9:30am Friday, September 8th, 2023 at 9:30am Friday, September 15th, 2023 at 9:30am Friday, September 22nd, 2023 at 9:30am Friday, September 29th, 2023 at 9:30am Friday, October 6th, 2023 at 9:30am Friday, October 13th, 2023 at 9:30am Friday, October 20th, 2023 at 9:30am Friday, October 27th, 2023 at 9:30am Friday, November 3rd, 2023 at 9:30am Friday, November 10th, 2023 at 9:30am Friday, November 17th, 2023 at 9:30am Friday, November 24th, 2023 at 9:30am Friday, December 1st, 2023 at 9:30am Friday, December 8th, 2023 at 9:30am Friday, December 15th, 2023 at 9:30am Friday, December 22nd, 2023 at 9:30am Select AllTotal Method of Payment Online Payment (Credit Card) eTransfer to ed.bca@bcaott.ca Credit Card by Phone Mailed Cheque 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 TerraceOttawa, OntarioK1C 2J7After 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 613-736-5921Please make sure to read and agree to the waiver above View and sign waiver aboveCredit CardCard Details Cardholder Name