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We are currently upgrading our online payment system. Online registration for 2011 will be available soon. Please check here again later.

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NEWS

  • A Mindful Tool for Recovery. Dominique Larocque Reframing:
    A Mindful Tool for Recovery.
    Read more at Podium Sports
    Journal more...
  • Skate Patrol Laces Upy Dominique Larocque supervises
    the Rideau Canal Skate Patrol
    team. Patrollers are on ice
    from Noon - 10PM (Mon-Fri), and
    from 10Am to 10PM (Weekends)
    Everyone Welcome!
  • Creative-Exploration Through Photography with Dominique Larocque Register today to our September photography workshop in collaboration with Harry Nowell Photography more...
  • Women and Wheels Read about LaRoccaXC on Citizen Cycle more...

Re-Connect – Re-Wild – Re-Wire


Nous préparons actuellement la version française de cette page. Consulter la version anglaise ci-dessous.

2011 LaRoccaXC MTB Club Membership

We are happy to offer online registration this year. You must complete a form for every program participant.

Please note that ALL mountain bike program participants are requested to also fill the Canadian Cycling Association Waiver, Release & Indemnity form prior to program participation. Please bring the form filled and signed on the day of your program. Parent or legal guardian can bring their child's form on the Monday morning of camp. We will also have forms on site at all times.

NOTE: LaRoccaXC membership is NOT mandatory for participation in instructional programs or Summer Camps. Also note that you only need to purchase insurance ($27.50) once.

If you wish to register by snail mail, you can complete this registration form and send with payment to:

177 Kehoe Street,
Ottawa, ON,
K2B 6A6

Please include your Canadian Cycling Association Waiver, Release & Indemnity form in your mailout.

Thank you.

Any field that has a red outline is a REQUIRED field.

2011 LaRoccaXC MTB Club Membership

Choose a club option for yourself or your family. Note that you must have taken a mountain bike instructional program with us in the past or in 2011 to become a LaRoccaXC member.

2011 MEMBERSHIP FEES

We thank you for your support.

Participation in any of our programs or memberships requires payment of QST, GST and and you must purchase OCA affiliation if you have not already done so. Riders without affiliation will not be allowed to participate.

$175

Adult memberships, save $25 for each additional adult.

$80

Youth memberships, save $10 for each additional youth.

$27.50

OCA Affiliation (non-taxable, per participant, ONE TIME ONLY). Ify you already have OCA Affiliation you do not need to purchase this.

REFUNDS:

All fees are non-refundable except with a physician's certificate. If you are registrating by snail mail, we accept $200 deposit along with post-dated payment of balance no later than 2 weeks prior to the start of session being attended. Minimum of 25 campers per week is required to run a session.

Participants

Enter the details for each participant. Save $10 for each additional participant.

Participant #1 (primary contact)
First Name Last Name
Year: Month: Day:
Date of Birth: Male Female

Participant #2
First Name Last Name
Year: Month: Day:
Date of Birth: Male Female

Participant #3
First Name Last Name
Year: Month: Day:
Date of Birth: Male Female

Participant #4
First Name Last Name
Year: Month: Day:
Date of Birth: Male Female

Participant #5
First Name Last Name
Year: Month: Day:
Date of Birth: Male Female

Contact

Please indicate how to contact you. You must provide telephone contacts, in case of emergency.

NOTE when entering a phone number, common formats are accepted. Some examples:

  • 613 123 4567
  • (613) 123-4567
  • 613-123-4567 x8910
Home #Work #Emerg. #
Email Email (Re-Type)
Street Address 1
Street Address 2
City
Province
Country
Postal Code

Your personal and address information will not be shared with any third party without your prior concent. We do not store credit card information of any kind on our web site.

Medical Information

It is of critical importance that you advise us of any medical issues that might put you to risk during your participation. Please call us at 613.820.1919 if you have any allergies to insects (bees, wasps, hornets, spiders). All information is kept strictly confidential.

Release Waiver

I Agree to the terms and conditions.

Click the Register Now button to proceed to online payment.

Ecards - Send a Wish! Newsletter - Sign Up!

NEWS

  • A Mindful Tool for Recovery. Dominique Larocque Reframing:
    A Mindful Tool for Recovery.
    Read more at Podium Sports
    Journal more...
  • Skate Patrol Laces Upy Dominique Larocque supervises
    the Rideau Canal Skate Patrol
    team. Patrollers are on ice
    from Noon - 10PM (Mon-Fri), and
    from 10Am to 10PM (Weekends)
    Everyone Welcome!
  • Creative-Exploration Through Photography with Dominique Larocque Register today to our September photography workshop in collaboration with Harry Nowell Photography more...
  • Women and Wheels Read about LaRoccaXC on Citizen Cycle more...

Re-Connect – Re-Wild – Re-Wire


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