Waiver Form

Participant Name

Phone Number

Gender
MaleFemale

Age

Outdoor Experience: Medical Information

Does the participant require medication during camp duration?
YesNo

Does your child have a disability or special needs?
YesNo

If yes, please describe the assistance your child may need during camp.

Please list any medical conditions our staff should be aware of.

Do you carry an Epi-Pen?
YesNo

If you answered yes to the above questions. Please list your severe allergy and any additional details. If this does not apply note N/A.

Travel Responsibility and Conduct

While traveling with Champions Technology INC. all Participants (including but not limited to Employees, participants, families, Spouses, Invited Guests, and Speakers) shall be expected to act in a reasonable, responsible, and safe manner. Participants shall continue to comply with Champions academy Employee Conduct Policies. Employees will also be held accountable for their actions and behavior during off-duty hours while traveling. Inappropriate conduct may be subject to discipline, up to and including dismissal.

In consideration of being permitted to travel to and participate in any way in Champions camp, I do hereby release, waive and discharge Champions technology INC. from any and all actions, damages, claims, or demands which I, my heirs, personal representatives, executors, administrators or assigns may have against any and all of the aforementioned for any and all personal injuries, accidents or illnesses, known or unknown, which I have or may incur by participation in the above-stated event and for all damages and loss to my property.

I understand that my traveling for and participation in this camp is voluntary and that this event carries with it certain dangers and risks. I realize that I am responsible for any injuries to persons or property which may be incurred in connection with my participation in this camp.

I, the undersigned, give Champions staff full permission to administer medication I bring myself such as Epi-Pen, asthma puffer, etc) if I fall ill and cannot do so for any reason. I give Champions staff my full consent to provide general non-perscription medication such as headache or stomach pills should I need and request it, and general medical care such as cleaning and bandaging, and do not hold them liable.

I, the undersigned, am at least 18 years of age. Or less than 18 years old and I have consent from my parents to travel. I have read this Travel Acknowledgement of Risk and Waiver of Liability and fully understand its terms. I acknowledge that I am signing this waiver freely and voluntarily with full knowledge of its significance. Any controversy or claim arising out of or relating to this Waiver shall be settled by arbitration in Ontario - Canada law shall apply.

Consent

Approval for Photos/Videos

I hereby grant permission to Heros Academy and its representatives to photograph and video my child, and otherwise capture my child’s image and to make recordings of my child’s voice for the purposes of sharing information about my child with me.

I further grant permission to Heros Academy. and its representatives to reproduce, use, exhibit, display, post or distribute any images and recordings of my child when such images or recordings are taken in a group, or in a multiple-child setting, to other parents who are also participating in the Heros Camp 27.

I hereby confirm and covenant that I will not share photos of any child (including group photos), other than my own, that I receive through the different channels with anyone other than Champions academy and its employees.
I hereby release, defend, indemnify, and hold harmless Heros Academy., its board of directors, officers, employees, or agents from and against any claims, damages, or liability arising from or related to the use of images, recordings, or materials of my child, whether individually or in a group setting.

I confirm that my health is in good standing and that I am capable of participating in physical activities.
I understand and accept the risks associated when participating in physical activities.

I confirm that I will respect Champions Academy, and its employees and that failure to do so will result in disciplinary action.
I accept that neither Champions academy INC., nor its instructors, staff, directors, contractors, and or affiliated members are liable for any injury or damages to myself or my property resulting from participating in activities or staying on site.

I have read, understand and agree to the above activity safety waiver.
Yes

participant Signature

Guardian/Parent’s Name and Signature

Date