2026 Youth Summit Registration
Eco Leaders Youth Summit - Thursday, April 23, 2026 6:30PM-8:30PM Pre-registration for participants

This is a Free event to learn, have fun and earn volunteer hours!
2 volunteer hours earned for attendance to the event
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First Name *
Last Name *
Which grade are you in?
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contact email *
Emergency contact information
Name/phone number/relationship
*
Participation Waiver
Image Release:
I express that I and/or my child has permission to participate in media coverage and photographs at Heartland Forest Nature Experience. I hereby grant Heartland Forest the right and permission to publish photos for the purpose of, without limitation, television, publication, and trade or advertising purposes. Accordingly, I release and discharge Heartland Forest staff & respective board members from any liability by virtue of blurring, distortion, alteration, optical illusion or use of composite from that may occur or be produced in taking of
said media or any processing through completion of the finished product.

Emergency Medical Consent:
By enrolling myself and/or my child in any Heartland Forest program/activity or event, I hereby authorize the procurement of whatever emergency medical treatment may be necessary for myself and/or my child. I also authorize the removal of myself and/or my child from Heartland Forest premises for the purpose of obtaining such emergency medical treatment if the need so arises. I agree to hold Heartland Forest Nature Experience
harmless for the nature, performance, and outcome of any such emergency medical treatment
and that the determination of whether an emergency has arisen shall be left to the sole
discretion of Heartland Forest Nature Experience.

Acknowledgement & Assumption of Risk:
The participant and parent or guardian acknowledge that they are aware of the details of programming and that there exists an element of personal risk or damage of serious injury in the activities and willingly agrees to assume responsibility for those risks as a condition of registering for the program.

Indemnification & Release:
I hereby represent that I and/ or my child has no physical restriction which would prohibit the participation in the activities of the programming. On behalf of myself and/or my child I save and hold harmless Heartland Forest Nature Experience or any of their agents, representatives, employees or assigns for my own and/or child’s health, safety, or any injury and/or disability arising out of or resulting from program or event activities.

I acknowledge and have read, understood and agree to the above Waiver, Release and Indemnity. I hereby understand that I and/or my child will follow the rules and regulations as set out by the organizers of the programming and that by not adhering to the rules and regulations, permission may or will be revoked and I and/or my child will be asked to leave the premises.

Heartland Forest reserve the right to remove any person from programming if any special needs have not been declared prior to attending. This ensures the safety and well-being of all participants. Please note: food and insect allergies do not qualify as special needs.
IF YOU ARE 18 OR OVER: I the undersigned confirm that I have reached the age of majority in Ontario and affirm that I am freely signing this agreement and I have read and understand this waiver and indemnity.

Signature
IF YOU ARE UNDER 18 HAVE YOUR PARENT/GUARDIAN SIGN: I am the parent or legal guardian of any participants listed above and affirm that I am freely signing this agreement and I have read and understand this waiver and indemnity.

Name of Parent/Legal guardian
signature of Parent/Legal guardian
email of parent/Legal guardian
Date:
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