Join Mark from Noojmowin Teg Health Centre to learn the skill of basketball. For kids 9 years and up.
To take place at Assiginack Public School from 3:05-4:15 pm. No cost. September 24th, October 1, 8, 15, 22 and 29
PARTICIPANT PERMISSION & WAIVER FORM and PHOTO RELEASE FORM
I, hereby release and discharge the Noojmowin Teg Health Centre/Township of Assiginack, its employees, officials, volunteers, and partners, including but not limited to from any injuries, damages, or lost or stolen articles that may result from my participation and/or my child’s participation in the soccer program.
As well, in exchange the Noojmowing Teg Health Centre/Municipality allowing my child/children to participate in this program, I fully agree to not hold the Noojmowing Teg Health Centre/Municipality of Assiginack or its staff responsible for any injuries, loss or damage sustained by my child or his/her property as a result of my child/children’s participation in this program or as a result of my child’s traveling to and from home or any other locations to the stated program. Further, I fully agree to pay the Municipality/Noojmowin Teg Health Centre for any damages done by my child to the property of persons as a result of my child’s participation.
Medical Authorization, I authorize the Municipality/Noojmowin Teg Health Centre and its staff to obtain all medical care, which they may deem necessary for my children or me as the case may be, in the event of an injury, I agree to reimburse the Municipality for expense(s) there by incurred.
I also authorize the Corporation of the Township of Assiginack/Noojmowin Teg Health centre to utilize any photographs, recordings, and/or comments of/from myself for promotional material and public viewing.
Name of participant
Age of participant
Phone in case of emergency
Any food allergies/special dietary requirements:
Name of parent/guardian
By signing my name below, I hereby certify that I have read all of the terms and conditions of this release and do intend to be legally bound thereby. By paying the registration fee and completing the form, I agree that this deems my approval and has the same force and affect as my signature. By paying the registration fee and completing the form, I agree that this deems my approval and has the same force and affect as my signature.
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