Participant Activity Registration Form

Name of Participant *

First

Last

Age of Participant *

• Under 18
• 18 and Older

Participant Phone Number

Participant Email

Please indicate program location and time participant will attend: *

• Ultimate Frisbee at Rankin School of the Narrows Thursdays 6 pm to 8 pm
• Pickleball at Rankin School of the Narrows Mondays 6 pm to 8 pm
• Pickleball at Boularderie Elementary Wednesdays 7 pm to 9 pm

Does the participant have any medical concerns? (Example has asthma and may require an inhaler) *

• Yes
• No

If yes, please list the medical concerns:

In case of an emergency please contact the following:

Emergency Contact Phone Number:

Relationship to Participant

Participant Activity Code of Conduct *

• I will show good sportsmanship to participants, instructors, officials, opponents, parents.
• I will encourage all participants and praise good efforts.
• I will be honest, fair and respectful to others at all times.
• I will be respectful of the facility and the staff of that facility.
• I will aim to learn all I can from the activities.

Participant Code of Conduct Acknowledgement *

• Participant has read, understands and is in agreement with the Participant Activity Code of Conduct
• If Participant is under the age of 18, Parent/Guardian has read, understands and is in agreement with the Participant Activity Code of Conduct.

READ BEFORE SIGNING Waiver and Release of Liability, In consideration of being allowed to participate in any way in the Municipality of the County of Victoria multi-activity program, related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 2. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 3. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the Municipality of the County of Victoria their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. *

• I have read and understand the document and its contents and hereby agree.

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of the activity and his/her responsibilities for adhering to the rules and regulations. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s/ward’s involvement or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.

PARENT OR GUARDIAN NAME

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