Summer Program Liability Waiver
Summer Program Liability Waiver
Community Services Department
This document is to be signed by “ the Participant ”: __________________________________________ together with the parent ( s ) or guardian ( s ): __________________________________________ in order to participate in the SUMMER PROGRAMS ( including children and youth ), and related events and activities ( collectively referred to as the “ Event ”).
IMPORTANT INFORMATION We , the undersigned Participant and the parent ( s ) and / or guardian ( s ) of the Participant , are aware that the Event involves inherent risks , dangers and hazards , involving all manner of injury or loss , including potentially serious or life-threatening injury and death , including , but not limited to :
a . the use of equipment , materials , or facilities related to the Event ; b . the actions or negligence of the Participant or other Participants in of the Event ;
c . the actions or negligence of Lac Ste . Anne County or its councillors , officers , employees , agents or representatives of any kind . ( Collectively referred to as the “ County ”); and
d . Any additional risks arising out of the Event .
We , the undersigned Participant , and the parent ( s ) and / or guardian of the Participant , freely accept and assume all such risks , dangers and hazards ; and the possibility of injury , death , property damage , property loss or any other loss or expense resulting to the Participant or myself / ourselves .
We , the undersigned Participant , and the parent ( s ) and / or guardian of the Participant , hereby agree as follows :
a . TO WAIVE ANY AND ALL CLAIMS of every nature and kind at law or equity or under any statute that I have or may have in the future against the County ;
b . TO RELEASE THE COUNTY from any and all liability for injury , death , property damage , property loss or any other loss or expense that I may suffer or that my next of kin or legal representatives may suffer as a result of participation in or use of the Event , due to any cause whatsoever , including negligence on the part of the County ;
c . TO HOLD HARMLESS AND INDEMNIFY THE COUNTY from any and all liability for injury , death , property damage , property loss or any other loss or expense to any party , including myself , as a result of participation in or use of the Event , or other financial loss or expense including , without restriction , legal expenses and costs on a solicitorand-his-own-client full indemnity basis in defending against such claims or enforcing the terms contained within this document ;
d . THAT THIS AGREEMENT WILL BE EFFECTIVE AND BINDING UPON myself , my heirs , next of kin , executors , administrators and assigns ; and
e . To allow the County to use photographs taken of myself or my child ( ren ) while attending or participating in an Event . Photographs may be used to promote the County ’ s Events and or activities in newsletters , brochures , advertisements intended for the general public . No other use of their photographs will be allowed .
I , the undersigned Participant and the parent ( s ) and / or guardian of the Participant , hereby acknowledge that we have read the foregoing , and have had the opportunity to ask questions and clarifications before signing , and have explained its meaning to the Participant . We acknowledge that we understand its content , import and meaning and hereby do agree , approve and consent to the above . The personal information being collected is being done in accordance with the Municipal Government Act and the Freedom of Information and Protection of Privacy Act ( FOIP ), and will be used as required by the County ’ s staff for the purpose of program registrations , promotion of programs , accounting purposes , and medical or emergency information .
Date : ______________ Participant Signature : _____________________ Parent / Guardian Signature : _____________________
T 780.785.3411 TF 1.866.880.5722 www . LSAC . ca Page 2 of 2
LSAC SUMMER PROGRAM REGISTRATION FORM & LIABILITY WAIVER