Multi-Activity Program Participant Application

Name of Participant

Age of Participant

Grade of Participant

Name of Participant’s School

Please indicate program location and time participant will attend:

Co-ed Participant age 10-13 Victoria Highlands Civic Centre

Does the participant have any food allergies?

Yes
No

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

Yes
No

Contact Information

Main Contact for Particpant

Phone

Email

Relationship to Particpant

Emergency Contact Information

Emergency Contact for Particpant

Phone

Email

Relationship to Particpant

By Clicking Here you acknowledge agreement to participate in the Multi-Activity Program and all associated activities within the realm of this program.

I Agree for my child to participate

Player Code of Conduct

I will show good sportsmanship to players, instructors, officials, opponents, parents and facility at every session.ce
I will learn the value of commitment by participating in as many sessions as I can.
I will encourage my teammates and praise good efforts.
I will be honest, fair, and respectful to others at all times.
I will aim to learn all I can from sports.
I will arrive at practice on time and be ready to dedicate my attention to my instructors.

Player Code of Conduct Acknowledgement

Participant has read and agreed to the Player Code of Conduct.
Parent / Guardian has read and agreed to the Player Code of Conduct.
Participant understands that any violation of the player Code of Conduct could result in removal or suspension from the Multi-Activity program.
Parent / Guardian understands that any violation of the player Code of Conduct could result in removal or suspension from the Multi-Activity program.

Parent Code of Conduct

I will put the emotional and physical well-being of youth participants ahead of a personal desire to win.
I will respect players, instructors, officials, spectators, families and facility at all times.
I will respect the decisions of instructors.
I will not engage in any violence or verbal threats or use any profanity.
I will not yell advice to my child during a session.
I will model good sportsmanship for all youth participants.
I will not belittle or ridicule anyone involved in a youth sporting program–in public, private, in-person, or online.
I will do my part to keep sports fun and positive for every youth participant.

By adding my name below I acknowledge that : I have read and agree to the Parent Code of Conduct. I understand that any violation of the Parent Code of Conduct could result in removal or suspension from the Multi-Activity program.

Please indicate below if you consent to your child’s photo being taken and/or used by Municipality of the County of Victoria for the purposes of promotion, advertising and/or to be shared on social media platforms.

Yes, I consent to my child’s photo being taken and/or used by Municipality of the County of Victoria for the purposes of promotion, advertising and/or to be shared within social media platforms.
No, I do not give my consent for my child’s photo being taken and/or used by Municipality of the County of Victoria for the purposes of promotion, advertising and/or to be shared within social media platforms.

READ BEFORE SIGNING 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.

Name of Parent or Guardian