IMPORTANT PLEASE READ:
Please Print out this form and bring it with you to the Edmonton Latin Festival.
In order to participate, you are required to have a signed liability form.
We will have a few extra forms onsite but because we are 100% non-profit organization, a small fee to recuperate costs for printing and paper will be charged.
We would rather you not have to pay for a form so we encourage you print and bring your own form. :)
Edmonton Hispanic Cultural Society
REGISTRATION: August 18-19, 2012
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
WARNING! BY SIGNING THIS FORM YOU GIVE UP IMPORTANT LEGAL RIGHTS
INCLUDING THE RIGHT TO SUE. PLEASE READ CAREFULLY!
(MUST print n this Section)
NAME OF PARTICIPANT, VOLUNTEER or PERFORMER:______________________________________________________
ADDRESS OF PARTICIPANT, VOLUNTEER or PERFORMER:___________________________________________________
CITY:________________________ PROV:________ POSTAL CODE:___________________
PHONE NO: ________________
E-MAIL ADDRESS___________________________@________________________________
EMERGENCY CONTACT: _____________ RELATIONSHIP: ______________ PHONE NO:_________________
Minors must be accompanied by an adult.
DISCLAIMER CLAUSE
The instructors, Edmonton Hispanic Cultural Society, and The Edmonton Hispanic Cultural Society their officers, directors, agents, contractors, employees, coaches/instructors, trainers, volunteers, members and representatives, the manufacturers and distributors of the equipment used in any event or program (all hereafter collectively referred to as “the Releasees”), are not responsible for any injury, loss or damage of any kind sustained by any person while registered and/or participating in any and all Edmonton Hispanic Cultural Society sanctioned activities, events, practise sessions or social activities (all hereafter collectively referred to as “Edmonton Hispanic Cultural Society Recreation Activities”), including injury, loss or damage which might be caused by the negligence of the Releasees.
DEFINITIONS
In this agreement the term “event or program” shall include all activities, programs, events, classes, and services provided, sponsored or organized by the Releasees including but not limited to:social activities, volunteering for the Edmonton Hispanic Cultural Society, eating event food at any event or program, performing in a performance of any type, yoga, pilates, weight training, dance, tennis, squash, step, bootcamp, martial arts, and all other such related activities.
In this agreement the term "participant" shall include performer, volunteer and paid temporary employee.
DESCRIPTION OF RISKS
In consideration of participation in any programs, I acknowledge that I am aware of, and freely accept the possible risks, dangers and hazards associated with being a participant, volunteer or performer, including the possible risk of severe or fatal injury to myself or others. These risks include but are not limited to:
a) all manner of injuries resulting in muscular injuries and soft tissue injuries including bruises, scrapes, cuts, etc, from executing strenuous and demanding physical techniques, contact with other participants, volunteers or performers and failure in proper use of equipment either by myself or other participants, volunteers or performers;
b) all manner of injuries resulting in sprains, dislocations, concussion, and broken bones, heart attack/stroke, spinal injury and tendonitis;
c) all manner of head, facial, eye and/or dental injuries;
d) all manner of medical problems resulting from heat exhaustion, dehydration, asthma, communicable diseases, food poisoning, skin rashes, cramps, chemical poisoning, and lack of fitness or conditioning;
e) that my risk of injury increases as I become fatigued;
f) all manner of injures and/or death that could result from a physical confrontation whether caused by myself or someone else; and
g) all manner of injuries and/or death that may result from collision with other participants on foot, bikes, motor vehicles and/or buses.
h) all manner of negligent advise regarding fitness programs
Initials: _________
MEDICAL/HEALTH & TRAVEL INSURANCE
1. I AM SOLELY RESPONSIBLE to select and purchase adequate medical/health insurance. No medical/health insurance will beprovided by the Releasees. In the event of a medical/health problem, the Releasee accepts no responsibility for any costs associated with a medical/health problem nor will they pay for any medical/health expenses, which may be incurred by my participation in any programs( as a particpant, volunteer or performer) provided by Edmonton Hispanic Cultural Society.
I freely accept and assume all responsibility to provide myself with medical/health insurance coverage.
Initials:_________
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of the Edmonton Hispanic Cultural Society allowing me participation in any events or programs, I agree:
1. TO ASSUME AND ACCEPT ALL RISKS arising out of, associated with or related to my participating in the Edmonton Hispanic Cultural Society's events or programs.
2. TO RELEASE THE RELEASEES from any and all liability from any loss, damage, injury or expense that I may suffer, or that my next of kin may suffer as a result of my participation in any events or programs due to any cause whatsoever, including breach ofcontract, or breach of any Statutory or Other Duty of Care, including any Duty of Care Owed under the Occupiers’ Liability Act,RSA 1980 C. 0-3, on the part of the Releasees;
3. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES:
a) from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my participation in any events or programs;
b) from any and all claims, demands, actions and costs which might arise out of my participating in theevents or programs, even though such claims, demands, actions and costs may have been caused by the negligence of the Releasees.
Initials: _________
ALBERTA Freedom of Information and Protection of Privacy Act (FOIPP): By signing below, I consent to having the information in this document collected by the Edmonton Hispanic Cultural Society. Certain personal information may be made available to federal and provincial government departments and agencies under appropriate legislative authority. Personal information is protected under the Alberta FOIPP Act. For further information, contact Information and Privacy Office at (780) 492-9419.ACKNOWLEDGEMENT
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, executors, administrators and representatives.
SIGNED THIS __________________ day of __________________________, 20 _______, at Edmonton, Alberta.
______________________________ ______________________________
Signature of Participant Signature of Witness
______________________________ ______________________________
Printed Name of Participant Printed Name of Witness
This agreement must be completed in full (signed, dated, witnessed, and initialled where indicated) before any participant may begin in any event or program.
Please Print out this form and bring it with you to the Edmonton Latin Festival.
In order to participate, you are required to have a signed liability form.
We will have a few extra forms onsite but because we are 100% non-profit organization, a small fee to recuperate costs for printing and paper will be charged.
We would rather you not have to pay for a form so we encourage you print and bring your own form. :)
Edmonton Hispanic Cultural Society
REGISTRATION: August 18-19, 2012
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
WARNING! BY SIGNING THIS FORM YOU GIVE UP IMPORTANT LEGAL RIGHTS
INCLUDING THE RIGHT TO SUE. PLEASE READ CAREFULLY!
(MUST print n this Section)
NAME OF PARTICIPANT, VOLUNTEER or PERFORMER:______________________________________________________
ADDRESS OF PARTICIPANT, VOLUNTEER or PERFORMER:___________________________________________________
CITY:________________________ PROV:________ POSTAL CODE:___________________
PHONE NO: ________________
E-MAIL ADDRESS___________________________@________________________________
EMERGENCY CONTACT: _____________ RELATIONSHIP: ______________ PHONE NO:_________________
Minors must be accompanied by an adult.
DISCLAIMER CLAUSE
The instructors, Edmonton Hispanic Cultural Society, and The Edmonton Hispanic Cultural Society their officers, directors, agents, contractors, employees, coaches/instructors, trainers, volunteers, members and representatives, the manufacturers and distributors of the equipment used in any event or program (all hereafter collectively referred to as “the Releasees”), are not responsible for any injury, loss or damage of any kind sustained by any person while registered and/or participating in any and all Edmonton Hispanic Cultural Society sanctioned activities, events, practise sessions or social activities (all hereafter collectively referred to as “Edmonton Hispanic Cultural Society Recreation Activities”), including injury, loss or damage which might be caused by the negligence of the Releasees.
DEFINITIONS
In this agreement the term “event or program” shall include all activities, programs, events, classes, and services provided, sponsored or organized by the Releasees including but not limited to:social activities, volunteering for the Edmonton Hispanic Cultural Society, eating event food at any event or program, performing in a performance of any type, yoga, pilates, weight training, dance, tennis, squash, step, bootcamp, martial arts, and all other such related activities.
In this agreement the term "participant" shall include performer, volunteer and paid temporary employee.
DESCRIPTION OF RISKS
In consideration of participation in any programs, I acknowledge that I am aware of, and freely accept the possible risks, dangers and hazards associated with being a participant, volunteer or performer, including the possible risk of severe or fatal injury to myself or others. These risks include but are not limited to:
a) all manner of injuries resulting in muscular injuries and soft tissue injuries including bruises, scrapes, cuts, etc, from executing strenuous and demanding physical techniques, contact with other participants, volunteers or performers and failure in proper use of equipment either by myself or other participants, volunteers or performers;
b) all manner of injuries resulting in sprains, dislocations, concussion, and broken bones, heart attack/stroke, spinal injury and tendonitis;
c) all manner of head, facial, eye and/or dental injuries;
d) all manner of medical problems resulting from heat exhaustion, dehydration, asthma, communicable diseases, food poisoning, skin rashes, cramps, chemical poisoning, and lack of fitness or conditioning;
e) that my risk of injury increases as I become fatigued;
f) all manner of injures and/or death that could result from a physical confrontation whether caused by myself or someone else; and
g) all manner of injuries and/or death that may result from collision with other participants on foot, bikes, motor vehicles and/or buses.
h) all manner of negligent advise regarding fitness programs
Initials: _________
MEDICAL/HEALTH & TRAVEL INSURANCE
1. I AM SOLELY RESPONSIBLE to select and purchase adequate medical/health insurance. No medical/health insurance will beprovided by the Releasees. In the event of a medical/health problem, the Releasee accepts no responsibility for any costs associated with a medical/health problem nor will they pay for any medical/health expenses, which may be incurred by my participation in any programs( as a particpant, volunteer or performer) provided by Edmonton Hispanic Cultural Society.
I freely accept and assume all responsibility to provide myself with medical/health insurance coverage.
Initials:_________
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
In consideration of the Edmonton Hispanic Cultural Society allowing me participation in any events or programs, I agree:
1. TO ASSUME AND ACCEPT ALL RISKS arising out of, associated with or related to my participating in the Edmonton Hispanic Cultural Society's events or programs.
2. TO RELEASE THE RELEASEES from any and all liability from any loss, damage, injury or expense that I may suffer, or that my next of kin may suffer as a result of my participation in any events or programs due to any cause whatsoever, including breach ofcontract, or breach of any Statutory or Other Duty of Care, including any Duty of Care Owed under the Occupiers’ Liability Act,RSA 1980 C. 0-3, on the part of the Releasees;
3. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES:
a) from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my participation in any events or programs;
b) from any and all claims, demands, actions and costs which might arise out of my participating in theevents or programs, even though such claims, demands, actions and costs may have been caused by the negligence of the Releasees.
Initials: _________
ALBERTA Freedom of Information and Protection of Privacy Act (FOIPP): By signing below, I consent to having the information in this document collected by the Edmonton Hispanic Cultural Society. Certain personal information may be made available to federal and provincial government departments and agencies under appropriate legislative authority. Personal information is protected under the Alberta FOIPP Act. For further information, contact Information and Privacy Office at (780) 492-9419.ACKNOWLEDGEMENT
I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, executors, administrators and representatives.
SIGNED THIS __________________ day of __________________________, 20 _______, at Edmonton, Alberta.
______________________________ ______________________________
Signature of Participant Signature of Witness
______________________________ ______________________________
Printed Name of Participant Printed Name of Witness
This agreement must be completed in full (signed, dated, witnessed, and initialled where indicated) before any participant may begin in any event or program.
