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...Date month day year last name first street telephone city province cell phone postal code email g seasonal program newsletter via yes no birthday birth gender emergency information contact relationship home work medical if you are not fully self sufficient must have your own personal support worker present while at the centre to see needs do hold a para transpo card please provide dates of covid vaccinations any wish us be aware list below privacy photography and membership waiver we protect respect is used communicate within our organization or sell this outside photograph permission photographs may taken on occasion in publicity materials including website media representatives attend events publish broadcast video other participants take that has control over how these general i hereby agree release absolve harmless gloucester its members directors employees independent contractors agents connected with from against blame liability for injury corona virus loss inconvenience damage s...