PD DAY CAMP (Rockbox & PowerPlay)
Camp Date: November 6, 2020, 9AM to 3PM
Camp Price: $60 + HST ($67.80)
Event Address: Kapuskasing Sports Palace (70 Brunelle Road N, Kapuskasing, ON)
Contact us at (705) 332-1223 or
if you have questions.
One registration form per athlete. The first 12 athletes registered for each group through this form will have priority on camp spots.
Participant Last Name
Participant First Name
Date of Birth
Which group are you registering for?
Allergies / Medical Conditions:
Since we will be having nutrition sessions and performing physical activity, please tell us notify us of any items that would be important for us to know!
Parent Last Name
Parent First Name
Parent Mobile Phone
How would you like to pay?
Camp Fee can be paid to: Cash-> Sheldon Reasbeck, E-Transfer ->
“The Participant” IN CONSIDERATION of permission granted now or in the future by PowerPlay Hockey to the below named person to participate in a hockey camp program operated by PowerPlay Hockey, the Participant agrees and acknowledges: In this Agreement: (a) The “Activities” include but are not limited to the following sporting and recreational activities, either collectively or individually; Ball Hockey, Dryland Training, Biking, Hiking, Ice Hockey, Nutrition Sessions, Classroom Sessions, Water Sports, Swimming, Basketball, Dodgeball, Fitness Testing, Weight Training, Fundamental Movement Skills (“FMS”), Ice Skating, Lacrosse. (b) The “Facilities” means the premises and facilities known as Rockbox Crossfit, Kapuskasing Sports Palace, and/or Whitney Arena as well as such other off-site third party facilities as may be used from time to time in conjunction with Activities conducted as part of the summer and winter programming including, but not necessarily limited to, the Kapuskasing Donat Brousseau Pool, Kapuskasing District High School, Cite Des Jeunes Track and Gym, Moonbeam Nature Trails, Remi Lake.(c) The “Releasees” means PowerPlay Hockey and its directors, officers, employees, instructors, agents, representatives, independent contractors, subcontractors, volunteers, successors and assigns, as well as any third party facility providers used in conjunction with the Activities and Facilities; (d) “Participating in” means going to, coming from, before, after or during. ASSUMPTION OF RISKS The Participant is aware that participating in the Activities involves many risks, dangers and hazards including, but not limited to personal injury, death or property loss or loss resulting therefrom, and NEGLIGENCE ON THE PART OF THE RELEASEES. THE PARTICIPANT UNDERSTANDS THAT NEGLIGENCE INCLUDES FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT THE PARTICIPANT FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE. The Participant is also aware that the risks, dangers and hazards referred to above exist throughout the Facilities and that many hazards are unmarked. THE PARTICIPANT FREELY ACCEPTS AND FULLY ASSUMES ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, SICKNESS, DEATH, OR PROPERTY DAMAGE OR LOSS RESULTING THEREFROM. RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT In consideration of the Releasees accepting my application for participation in the Activities with PowerPlay Hockey and permitting my use of Facilities, the Participant hereby agrees as follows:
WAIVE ANY AND ALL CLAIMS that the Participant has or may in the future have against THE RELEASEES, and TO RELEASE THE RELEASEES from any and all liability for any loss, damage, expense or injury including death that the Participant may suffer, or that the Participant’s next of kin may suffer, resulting from either the Participant’s use of or the Participant’s presence on the facilities or participation in the Activities, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER ANY APPLICABLE OCCUPIERS’ LIABILITY LEGISLATION ON THE PART OF THE RELEASEES. THE PARTICIPANT UNDERSTANDS THAT NEGLIGENCE INCLUDES FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT THE PARTICIPANT FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE; 2. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to property of or personal injury to any third party, resulting from the Participant’s use of or presence on the facilities or participation in the Activities; 3. This Release Agreement shall be effective and binding upon the Participant’s heirs, next of kin, executors, administrators, assigns; and representatives, in the event of the Participant’s death or incapacity; 4. This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the Province of Ontario and no other jurisdiction; 5. Any litigation involving the parties to this Release Agreement shall be brought solely within the Province of Ontario, and shall be within the exclusive jurisdiction of the Courts of the Province of Ontario; and 6. In entering into this Release Agreement the Participant is not relying upon any oral or written representations or statements made by the Releasees with respect to the safety of participating in the Activities other than what is set forth in this Agreement. THE PARTICIPANT OR HIS/HER LEGAL GUARDIAN HAVE READ AND UNDERSTAND THIS RELEASE AGREEMENT, AND ARE AWARE THAT BY SIGNING THIS AGREEMENT, THE PARTICIPANT IS WAIVING CERTAIN LEGAL RIGHTS WHICH THE PARTICIPANT OR THE PARTICIPANT’S HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES. PowerPlay Hockey Media ReleasePowerPlay Hockey is collecting personal information for the purpose of promoting PowerPlay Hockey, in media communications of any kind produced by or on behalf of PowerPlay Hockey and for no other purpose. In consideration for my participation in the media communications promoting camp produced by or on behalf of PowerPlay Hockey, I give PowerPlay Hockey, its employees and agents: 1. The perpetual and non-exclusive right and license to use my image, my name and/or a description of my camp experience in any of the media communications promoting the camp produced by PowerPlay Hockey, without payment of royalties to me;2. Consent under the Privacy Statement to use and disclose my image, my name and/or a description of my experience to the media or use for in any of the media communications promoting camp produced by or on behalf of PowerPlay Hockey.I understand and agree that the media communications will include but not necessarily be: PowerPlay Hockey website, newspaper/magazine articles, photos, brochures, social media and advertisements. I waive any right to inspect or approve the finished media communications.I release and agree to hold harmless PowerPlay Hockey, its employees, representatives, agents and assigns, from all actions, claims and demands arising from PowerPlay Hockey’s use and disclosure of my child’s image, his/her name and/or a description of his/her experience in the production, reproduction or distribution of any of the media communications.I have read this Release and Consent form before signing below, and I understand the contents. I hereby certify that I am the parent or guardian of the above-named minor who is under the age of 18 years. For the consideration above, I consent that any images of the minor, recordings of the minor’s voice, use of the minor’s name and/or descriptions of the minor’s PowerPlay Hockey experience initiative which have been or are about to be recorded by or on behalf of PowerPlay Hockey may be used and disclosed by it for the purposes and under the rights set above, signed by the minor, with the same force and effect as if executed by me.
I consent to be the parent of the above mentioned participant. I have read the above waiver and I accept everything mentioned in this waiver.
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