INFORMATION FORM & PERMISSION SLIP URBAN RECREATION (ALTERNATIVE ED. WEEK)

Transcription

1 INFORMATION FORM & PERMISSION SLIP URBAN RECREATION (ALTERNATIVE ED. WEEK) Westgate Mennonite Collegiate 86 West Gate Winnipeg, Manitoba Canada R3C 2E1 Tel: (204) Fax: (204) Dear Parents and Guardians; This is to inform you of plans for the Urban Recreation group during Alternative Education Week and to request permission for your son or daughter to participate. Dates: Monday, June 16 through Thursday, June 19, 2014 Teachers in Charge: Jason Dyck, Jen How and Ruth Dyck Cost: $ 60. (Please include with permission slip) Students arrange their own transportation and lunches Please be sure to avoid sunstroke/sunburn/dehydration bring water, hat, sunglasses, sunscreen, bug spray MONDAY: Friz-Knock and Ten-Pin Bowling 9:00 to 11:30 a.m. Happyland Park, Marion and Dufresne (near Archibald St.) 12:30 to 2:30 p.m. Salle des Quilles Laverendrye Bowling Lanes, 614 Rue Des Meurons Tuesday: 10:00 a.m. Dragon Boat 10:00-2:30 Lunch at the forks p.m. Kayaking Pick up and Drop off point : Manitoba Canoe and Kayak Center 80 Churchill Drive Wednesday: Baseball and Wall Climbing 10:00 to12:00 p.m. Baseball -Assiniboine park east side 1:00 a.m. to3:00 Vertical Adventures Indoor Climbing Facility, 77 Paramount Rd. Waiver form required (Please include with permission slip) Clean (indoor) shoes (or $3 rental) required THURSDAY: Golf (students should have signed up for one of the options below) 10:00 a.m. to approx. 3:30 p.m. Tuxedo Golf Centre, 400 Shaftesbury Blvd. Students provide (or rent) own clubs, etc. Please fill out the bottom portion and return it, along with payment and waiver form, To Ruth Dyck before Thursday, June 05 th. Please be aware that telephone calls cannot be accepted as substitutes for this permission slip. Thank you. Please do not hesitate to call if you have further questions.

2 I, give permission for (parent s signature) (student s name) to attend Urban Recreation during Alternative Education Week, June 16 to 19, (Please return, with $60. and waiver, to R. Dyck)

3 WAIVER FORM READ THOROUGHLY AND CAREFULLY BEFORE SIGNING Participant risk acknowledgement, release, waiver of claim and assumption of risk for Vertical Adventures and use of the climbing wall. In consideration of permission granted now or in the future by Vertical Adventures (The "Owner") to use the Vertical Adventures Climbing Wall (the "Climbing Wall") or participate in any of the activities associated with the same, I agree and acknowledge that: 1. I have met all the prerequisites required for participation and use of the Climbing Wall. 2. I will abide by the rules and regulations imposed upon all participants in the use of the Climbing Wall, and I recognize that it is my sole responsibility to acquaint myself with them. 3. I am fully aware that there are risks and hazards inherent in the very nature of the use of the Climbing Wall. I have full knowledge of the nature and extent of these risks and that in using the Climbing Wall I may suffer personal injury, death or property loss. The particulars of these types of injuries include, but are not limited to: a) Any injury resulting from falling and impacting against the Climbing Wall faces or the ground; b) Rope abrasion, entanglement, and other injuries resulting from activities on the Climbing Wall face; c) Cuts and abrasions resulting from skin contact with the Climbing Wall; d) Injury which results from falling equipment or contact with other persons using the Climbing Wall. e) Injury which results from failure of ropes, slings, harnesses, climbing hardware, anchor points, or any other part of the climbing structure; 4. I acknowledge that the option not to wear a helmet or use any other recognized safety equipment on the Climbing Wall exposes me, as a participant, to increased risks. I acknowledge that Vertical Adventures has advised me to use a helmet and other safety equipment. 5. With this knowledge, I nevertheless, freely and voluntarily assume the risks involved in the use of the Climbing Wall exposes me, as a participant, to increased risks. I acknowledge that Vertical Adventures has advised me to use a helmet and other safety equipment. 6. I hereby release and forever discharge and hold harmless Vertical Adventures, its Directors, Officers, employees, volunteers, agents, and contractors (All hereinafter referred to as the "Releasees") of and from any and all claims, demands, damages, proceedings, expenses, actions, or causes of action in law or in equity in respect to any death,

4 injury, loss, or damage to myself or to my property howsoever caused and arising or to arise by my use of the Climbing Wall including, without limiting the generality of the foregoing, the negligence of the Releasees. 7. I agree to indemnify and save harmless the Releasees for any claim, including any claim for medical services arising from the use of the Climbing Wall. 8. I am aware of the nature and effect of this Release, Waiver of Claim and Assumption of Risk, my voluntary signature on this Release, Waiver of Claim and Assumption of Risk is binding upon myself, my heirs, my executors, administrators and assigns. 9. This Release and Waiver of Claim shall be binding upon me, my heirs, executors, administrators and assigns. 10. I am executing this Release and Waiver of Claim and Assumption of Risk freely and voluntarily without any compulsion on behalf of Vertical Adventures. If Participant is Over 18 Years of Age Page 2 Of 2 Revised 07 November I acknowledge that I have read this entire Agreement prior to signing it. Intending to be legally bound I have signed this Release, Waiver of Claim, and Assumption of Risk on this day of, 20, in the City of Winnipeg, in the Province of Manitoba. Surname (Please Print) First Name (Please Print) Witness Signature Signature of Participant Only Complete If Participant is Under 18 Years of Age I,, agree in consideration of my child's / my ward's use of the Climbing Wall to indemnify and save harmless Vertical Adventures for any lawsuits or actions, claims or demands by reason of damage, loss, death or injury to my child / my ward or his or her property not withstanding that the same may have been contributed to or occasioned by the negligence of the Releasees. I acknowledge that I have read this entire agreement prior to signing it and that I intend to be bound by all of its terms. Intending to be legally bound, I have signed this Release, Waiver of Claim, and Assumption of Risk this day of, 20, in the City of Winnipeg, in the Province of Manitoba. Witness Signature of Parent or Guardian if Participant is under 18 years of age Child's Name: EMERGENCY CONTACT NAME PHONE Registration Form (PLEASE PRINT)

5 Do you have any medical conditions we should be aware of? If yes, please explain. Have you taken a climbing course before? If yes, what course and where? Have you belayed before? What type of device

6 WAIVER AND RELEASE (To be completed by every student and submitted at first practice) IN CONSIDERATION OF the acceptance of my entry in a school paddling lesson/clinic, I hereby waive and release the Manitoba Paddling Association, its directors, officers, employees, agents, representatives, volunteers, successors and assigns from and against all claims, actions, demands, costs and expense in respect to death, injury, loss or damage to my personal property, howsoever caused, contributed to or occasioned by the negligence of the Corporation, its directors, officers, employees, agents, representatives, successors and assigns. This Waiver and Release shall be binding upon myself, my heirs, executors and administrators. By signing this form I am issuing my consent for the following information to be used by The Manitoba Paddling Association for administrative purposes. I hereby grant permission to any of the above, described persons to use any pictures of myself or my likeness while participating in this program without obligation or liability to me. This information may be used to contact you with information regarding programs and services offered by The Manitoba Paddling Association and our partners. This information will NOT be distributed to any outside organizations. I do not want to receive information regarding future programs and services offered by the Manitoba Paddling Association and our sponsors. PLEASE COMPLETE SECTIONS I and/or II: I acknowledge that I am the full age of eighteen years, if not, I have obtained the consent of my parents to participate in this program. I acknowledge that I have read this document before signing it and have had and opportunity to obtain an explanation as to its contents. Dated this day of, 2014 WITNESS PARTICIPANT S SIGNATURE If the participant is under eighteen years of age, the following should be completed by the parent or legal guardian of the participant. I, being a parent of legal guardian of, hereby agree that (NAME OF PARTICIPANT) the foregoing Waiver and release shall be binding upon my child. Dated this day of, WITNESS ADDRESS PARENT S SIGNATURE