Westend Seniors Activity Centre

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Westend Seniors Activity Centre

"Come Join Us & Meet New Friends"

Membership Form

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If you would like to watch a video of our centre please click on this Link http://www.youtube.com/watch?v=W3_hkTaNS7

If you would like to download and easy to print pdf version of our membership form click on box below

How Do You Become A Member?
Please print the following form and bring it in to our centre or mail it with your $25 cheque to:
Westend Seniors Activity Centre
9629-176 Street
Edmonton, Alberta T5T6B3

How Much Does It Cost?
$25 translates to only $2.08 a month! This small amount of money is just enough to cover the expense of a monthly newsletter, program guide and the time it will take to enter your information into the database.

For $25 a year you get:
- Access to programs and services
- Latest information on seniors resources
- An opportunity to meet new friends
- A chance to enjoy the beautiful facility including the cafeteria, library, games room, etc.

Membership Application Form


(Last name)	(First name)	(Initials/Middle name)


(Address)	(City/Town)	(Prov.) (Postal code)


(Telephone #)	(Birthday)	(Month - Day - Year)

Email Address

Please state if you are Male or Female

Emergency Contacts (must be completed)


Name	Relationship


Home Telephone#	Work Phone#


Name	Relationship


Home Telephone#	Work Phone#

1. Are there medical conditions that the staff should note in case of emergency at the Centre?

2. For statistical purposes for our funding please state whether you live alone or with others.

3. 3. Do you have interests, hobbies or acquired skills? If so, what are your areas of interest?

Are you willing to share these with others by assisting with projects at the centre? Yes No

Instructing others? Yes No

4. Former Occupation

5. Past Employer

Do you have any interest in Volunteering a few hours a month to the Centre?

Yes No Not Sure

If yes, please indicate which areas you would be interested in helping with:


Signature	Date

Program Waiver

I ____________________________________________ recognize that the activities of the club/program I will be participating in may have some inherent risks. I knowingly and voluntarily assume the risks of engaging in this activity. I acknowledge that it is my responsibility to be aware of the risks associated with the activity and to safeguard my person by ensuring:

1. That I am physically able/capable of the activity.

2. That I exercise safety measures appropriate to the activity, and

3. That I do not participate beyond my capabilities.

I understand that although Westend Seniors Activity Centre endeavors to provide competent leadership and instruction for the club/program I am joining, it can not warrant in anyway, their competency or professionalism. I acknowledge that Westend Seniors Activity Centre organizes activities only and does not necessarily possess any special skill or knowledge in relation to any of the activities.

I hereby release Westend Seniors Activity Centre from any liability arising out of my participation.

Name (print)______________________________________ Phone ____________________

Address _________________________________________

Signed ___________________________________________ Date______________________

This Waiver is effective for the duration of membership with Westend Seniors Activity Centre

You may search our web site for all documents containing matching words or patterns.

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Westend Seniors Activity Centre
9629-176 Street Edmonton, Alberta T5T 6B3
Tel: 780-483-1209 FAX: 780-484-7738
Email: weseniors@westendseniors.com

If you would like to watch a video of our centre please click on this YouTube Link http://www.youtube.com/watch?v=W3_hkTaNS7o
For More Information Call 780-496-1611 or click on this link www.edmonton.ca/transportation.aspx
Bus Route Maps for buses that come close to Westend Seniors	Bus 109 Route Bus 111 Route Bus 150 Route Bus 311 Route