• 50+ Application Form

    50+ Application Form

    for Winter 2025 Activities

  • Before you begin....

  • Complete and submit this form before Dec 31, 2024 to apply for the Winter 2025 semester.

    Note: We recommend that before you begin filling in this form that you first visit the Brockville 50+ website to review and become familiar with the activity descriptions, pre-requisites and schedules for your activities of interest.

    Go to 50+ Activity Descriptions

    Go to 50+ Activity Schedules

    If you wish to make any application changes after you have pushed the Submit button, you will need to submit a completely new application with all your choices.  The most recent application we receive from you will be accepted and all previous submissions will be automatically deleted.

    You will be sent an email confirming your application has been received.


  •

  • Activity Selections

    Before making your selections, ensure you have read and understand the activity description, pre-requisites and the level of endurance required for the activity.

    The activity descriptions and pre-requisites can be found in the Activity Descriptions at fiftyplusbrockville.ca.

    The following section lists all the activities organized into seven categories. When you click on a category title, a drop down list of those associated activities will appear.

    Then use the drop down menu beside each activity and click on your priority choice for that activity. 

    In an effort to be fair to all applicants we have implemented a priority selection process.  We ask that you only select one Priority1 and/or one Priority2 and/or one Priority3 and/or as many Priority4's as you plan to attend.

    Some activities only have a Priority 4 choice because either you are guaranteed to be accepted or the leader will select participants by lottery.  In either case you are prevented from wasting a higher level priority.  

    To reiterate:

    You may select only one Priority 1.
    You may select only one Priority 2.
    You may select only one Priority 3. 
    You may select as many Priority 4's as you plan to attend. 

    IMPORTANT:  If you apply for more than one Priority 1, or more than one Priority 2, or more than one Priority 3, your application will be rejected and you will be notified.

    • YOGA & TAI CHI 
    •  
    • EXERCISES & DANCE 
    •  
    • SPORTS 
    •  
    • ARTS 
    •  
    • LANGUAGES 
    •  
    • MUSIC 
    •  
    • SPECIAL INTEREST 
    •  

    • PAYMENT INFORMATION

      If your Application form is received by December 31st AND payment is received at the Brockville 50+ office before January 11th, we are offering an EARLY BIRD rate of $40. After January 10th the application fee is $60. 

      The method of payment details will be provided when you complete this submission as well as in the application acknowledgment email you will receive. You can also go to Payment Terms  on the 50+ website.

    • PARTICIPANT WAIVER OF LIABILITY AGREEMENT

      I, the undersigned participant in one or more Brockville 50+ Activity Centre activities, as a condition of my participation, hereby for myself, my heirs, executors and administrators, waive any and all claims, in connection with or arising out of my participation or any injury to myself related hereto, I may have now or in the future against the Brockville 50+ Activity Centre, its class or activity organizers, instructors, leaders, and other volunteers.

      I, the undersigned participant, also understand that it is my responsibility to report any accident or personal injury to the 50+ office within 24 hours of occurrence (This is to ensure compliance with government health and safety regulations.)

      I, the undersigned participant, also understand it is my responsibility to ensure I have the ability and stamina to participate in the activities for which I am applying.

      I also hereby authorize the Brockville 50+ Activity Centre to routinely correspond with me using the email address already on file or as provided on the current registration form.

    • Note: the following signature panel can be completed using your pointing device.  If using a PC use your mouse, if using a mobility device use your finger tip.  Do the best you can, it won't be perfect.

    • Clear

    • Review Before Submitting

      Remember you should only have selected a single Priority 1, single Priority 2, single Priority 3 but you can have multiple Priority 4's.   

      Push the Review Answers Button to make sure all your information and selections are correct.

      After reviewing your information you can either use the Back to Form button to correct any information or click the Submit button to complete the application.

    • Should be Empty: