WAIVER & REGISTRATION: Haida Gwaii Recreation After School Sports and Arts Initiative (ASSAI)
Haida Gwaii Rec ASSAI registration and waiver forms made easy!

Please complete the form below once every school year. Each participating student, regardless of program, must submit this completed waiver BEFORE they take part in any Haida Gwaii Rec ASSAI programming.

Contact Laura Bishop, ASSAI Coordinator at hgrecafterschool@gmail.com or 250-626-9045 to register for specific programming and with any questions.

CONFIDENTIALITY: Registration and waiver forms, attendance sheets, and program information are safe-guarded by program staff. Unless required by law, Haida Gwaii Recreation ASSAI and staff will not use or disclose for any purpose personal information that has been collected, without the consent of the individual.

Participant Information
First Name
Your answer
Last Name
Your answer
Gender
Birth Year
Your answer
School
Grade
Village of Participant's Residence
Required
Medical, Psychological or Physical Conditions
Please describe any past or present medical, psychological or physical conditions which may affect the student's ability to participate in any program or activity. Include how they affect the student, the symptoms of onset and the causes or potential causes of onset.
Your answer
Parent/Legal Guardian 1
First Name
Your answer
Last Name
Your answer
Email
Your answer
Phone Number
###-###-####
Your answer
Parent/Legal Guardian 2
Optional
First Name
Your answer
Last Name
Your answer
Email
Your answer
Phone Number
###-###-####
Your answer
Emergency Contact
First Name
Your answer
Last Name
Your answer
Phone Number
###-###-####
Your answer
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IMAGE USE AGREEMENT/PHOTOGRAPHIC RELEASE
This section must be completed by all program participants over the age of 19, or by the parents/legal guardians of participants aged 19 or under. Please read and complete the information presented below.
Please check the following:
Please read carefully:
I give permission for the participant’s photograph to be used by the Haida Gwaii Regional Recreation Commission for promotional and reporting purposes.

This confirms my agreement and consent with the Directorate of Agencies for School Health BC (DASH BC) and Haida Gwaii Regional Recreation Commission regarding my participation in or related to the After School Sport and Arts Initiative in which my child may be photographed, filmed or videotaped (the “Image(s)”) from time to time. I understand that DASH BC and Haida Gwaii Regional Recreation Commission may wish to use for its own purposes certain Images that its representatives, consultants, employees or agents have taken of my child.

1. For valuable consideration received, I hereby irrevocably and unconditionally grant to DASH BC and Haida Gwaii Regional Recreation Commission the right to copyright and use, reuse, publish, republish and incorporate (alone or together with other materials) the Images without restriction through any and all media (including print, video, CD-ROM, internet and any other electronic medium presently in existence or invented in the future) for illustration, art, promotion, advertising, trade or any other purpose whatsoever, including its use and license to others as it sees fit in its discretion, and the right to the use of any printed material in connection therewith.

2. I hereby relinquish any right that I may have to examine or approve the Images or the use thereof in any manner whatsoever or printed material that may be used in conjunction therewith.

3. I will not, in any manner whatsoever, commence, maintain, pursue, continue or assign any action, cause of action, claim, suit, complaint or proceeding of any kind or nature whatsoever against DASH BC and Haida Gwaii Regional Recreation Commission, its partners, employees, servants, agents, or any person, corporation, partnership or other legal entity that could seek contribution or indemnity from DASH BC and Haida Gwaii Regional Recreation Commission, relating in any way to, or in any way connected with, the Images. I hereby agree that I will not bring or consent to others bringing claim or action against DASH BC and Haida Gwaii Regional Recreation Commission on the grounds that anything contained in the Images, or in the advertising and publicity used in connection herewith, is defamatory, reflects adversely on me or violates any other right whatsoever, including without limitation, rights of privacy and publicity.

4. I hereby release DASH BC and Haida Gwaii Regional Recreation Commission, its directors, officers, successors, assigns, representatives, consultants, employees, partners and agents from any liability that may occur as a result of said Images including, without limitation, any claims for invasion of privacy.

5. DASH BC and Haida Gwaii Regional Recreation Commission shall not be obligated to use the Images or to use any of the rights granted hereunder, or to prepare, produce, exhibit, distribute or exploit the Images. DASH BC and Haida Gwaii Regional Recreation Commission shall have the right to assign its rights hereunder, without my consent, in whole or in part, to any person, firm or corporation.

6. I have read the above prior to its execution and I fully understand the contents thereof; this agreement shall be binding upon me and my heirs, successors, legal representatives and assigns.

PARTICIPANT WAIVER, RELEASE, INDEMNITY AND CONSENT
This section must be completed by all program participants over the age of 19, or by the parents/legal guardians of participants aged 19 or under. Please read and complete the information presented below.
Please check the following:
Please read carefully:
I am aware that, by taking part in recreational programs and activities offered by the Haida Gwaii Regional Recreation Commission, I may be exposed to the possibility of injury, death, or other losses, including property damage. I willingly accept and assume all such risks, dangers, and hazards associated with my participating in such programs and activities, and the possibility of personal injury, death or loss which may result, directly or indirectly, from my participation. I hereby remise, release and forever hold harmless the Haida Gwaii Regional Recreation Commission, its employees, officers, leaders, agents, or representatives from all manner of actions or claims in relation to such risks and any associated injury, death or other loss including, without limitation, where any injury, death or loss is the direct or indirect result of negligence or gross negligence by the such employees, officers, leaders, agents or representatives.

I hereby remise, release and forever hold harmless the Haida Gwaii Regional Recreation Commission from any and all liability for any damage to property of, or personal injury to, any third party resulting from my participation in the recreational programs and activities.

In entering into this agreement I am not relying on any oral, written or visual representations or statements made by the Haida Gwaii Regional Recreation Commission.

I will inform the Haida Gwaii Regional Recreation Commission, and any leader or employee as required, of any medical, psychological or physical conditions which may affect my ability to participate in any program or activity.

I confirm that I am aged 19 years or older, and that I have read and understood this agreement prior to signing it, and agree that this agreement will be binding upon my heirs, next of kin, executors, administrators and successors. I agree that this agreement will be governed by and interpreted in accordance with the laws of British Columbia and Canada, as applicable. If the applicant is below 19 years of age, the parent or legal guardian signing consent to this agreement acknowledges and confirms that the applicant may participate in the recreational programs and activities offered by the Haida Gwaii Regional Recreation Commission, and that the participant release, waiver, indemnity and consent contained in this agreement applies to and is binding on the parent or legal guardian, and the indemnity extends to include any claim or action brought by any person associated with the applicant, or by any person on behalf of the applicant, or by any third party suffering any loss as a result of the actions of the applicant.

I understand that this waiver will be retained by the Haida Gwaii Regional Recreation Commission and will be valid for all recreation programs and activities offered in which I choose to participate.

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT, that I understand, appreciate and accept the risks associated with my participation or my child’s participation in this program and all of its related activities.
Participant Full Name
Your answer
Parent/Legal Guardian Full Name
Your answer
Participant/Parent/Legal Guardian Location
City, town, community where you are completing this form
Your answer
Today's Date
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