The Canicross Club Incorporated Member Application Form

Membership application form 1/4/25 to 31/3/26
Membership interpretation and fees

Individual membership: means a person 16 years of age and over
Annual fee $30.00

Junior membership: means a person under 16 years of age that has no voting rights and is accompanied by an individual member
Annual fee: $15.00

Family Membership: means up to two persons 16 years of age and over plus one or more persons under 16 years of age.
Annual fee $50.00

Please pay your membership via direct deposit (Surname as reference).

Account name: The Canicross Club Incorporated
BSB: 633 000
Account number: 205 194 913

Thank you
Payment Date

DayMonthYear
Date
Membership type*

IndividualJuniorFamily
I/We am mostly interested in (select all that apply)

CanicrossCanihikingSocial eventsRace events1 to 2 hour eventsMidweek eventsUp to 1/2 day eventsFull day eventsWeekend events
I/We can help the club and it's members with..... (please provide further information in the comments section)

Social mediaSponsorshipAdministrationLeading hikes/runsCanine servicesEventsFundraisingHuman servicesOther
Comments

Individual Membership
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Phone Number
Please enter a valid phone number.

Junior Membership
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Phone Number

Area CodePhone Number
Name of Parent/Guardian *

First NameLast Name
Phone Number of Parent/Guardian*
Please enter a valid phone number.

Family Membership
Adult 1*

First NameLast Name
Adult 2

First NameLast Name
Child 1

First NameLast Name
Child 2

First NameLast Name
Child 3

First NameLast Name
Child 4

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry
Phone Number
Please enter a valid phone number.

Activity Waiver

“I hereby release and discharge The Canicross Club Incorporated, its agents, employees, officers, directors, affiliates, successors and assigns from any and all claims, demands or causes of action that I may hereafter have for injuries or damages arising out of my participation in Canicross, Canihiking or any other club activities. This release is intended to discharge in advance The Canicross Club Incorporated, its agents, employees, officers, directors, affiliates, successors and assigns from any and all liability arising out of or connected in any way with my participation in any club activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. This waiver may not be modified orally. I represent that I have the authority to sign* this waiver on behalf of myself and/or any minor(s) listed.”

* By selecting the yes button below I am acknowledging this waiver in lieu of an actual signature.
Do you agree to and consent to the conditions in the waiver above*

Yes, I agree
Please note

We have insurance coverage for members via the AFSS, as well as some other benefits. We are in the early stages of putting a membership package together and ask for your patience during this club building phase.
Please verify that you are human (some dogs will try to join by themselves)*
Should be Empty:

Membership application form 1/4/25 to 31/3/26