Lac Ste. Anne County Summer Fun Book Summer Fun 2019 Book | Page 16

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
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
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
and-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
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
and medical or emergency information.
Date: ______________ Participant Signature: _____________________ Parent/Guardian Signature: _____________________
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780.785.3411
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1.866.880.5722 www.LSAC.ca
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LSAC SUMMER PROGRAM REGISTRATION FORM & LIABILITY WAIVER