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TOWN OF CANMORE

MINOR ACKNOWLEDGEMENT OF RISK

TODAY'S DATE: April 19, 2024

CONSENT AND ACKNOWLEDGEMENT OF RISK: MINOR PARTICIPANT

(hereinafter the "Consent and Acknowledgement of Risk Agreement")

BY SIGNING THIS CONSENT AND ACKNOWLEDGEMENT OF RISK AGREEMENT YOU ACKNOWLEDGE THAT THERE ARE INHERENT RISKS ASSOCIATED WITH CLIMBING, FITNESS, AND ARENA ACTIVITIES. SERIOUS INJURY OR DEATH COULD RESULT WHILE PARTICIPATING IN THESE ACTIVITIES.

PLEASE READ CAREFULLY!

Custodial Groups (birthday parties, sports teams, scout groups, school groups): If you are planning to enjoy the climbing gym or fitness areas as a group activity you are required to make a booking by contacting climbing@canmore.ca.

I Agree

 

Guardian or Parent:

TO: TOWN OF CANMORE, and its directors, officers, employees, instructors, assistant instructors, members, guests, volunteers, agents, independent contractors, subcontractors, representatives, successors and assigns and any other person or organization participating in or connected with the activities at Elevation Place, the Canmore Recreation Center and any indoor or outdoor venues managed or utilized by the Town of Canmore (hereinafter collectively referred to as the “RELEASEES”).

DEFINITION - RECREATION ACTIVITIES

In this Consent and Acknowledgement of Risk Agreement, the term "Recreation Activities" includes all activities, services, use of facilities, programs, orientations and instructional sessions, classes and clinics, events and other activities associated with the Canmore Recreation Centre, Elevation Place and any indoor or outdoor venues managed or utilized by the Town of Canmore, whether as a participant or a spectator, including, but not limited to, the following specific services and activities:

CLIMBING - climbing; rappelling; belaying; participating in or spectating at competitions, demonstrations, orientations and instruction sessions, seminars and courses; use of equipment, including but not limited to ropes, harnesses, slings, anchor points, climbing holds, or any other equipment.

FITNESS - fitness training, classes and clinics, aquatic centre use and other related activities.

AQUATIC - use of the swimming pool, participation in instruction sessions, water play, swimming, classes and clinics, third party facility rentals, and other related activities.

SKATING - use of the arena, participation in public skating sessions, drop-in programs, classes and clinics, and third party facility rentals and other related activities.

OUTDOOR ACTIVTY – Use of parks, playgrounds, courts, baseball diamonds, water venues, arenas and other spaces for structured and/or unstructured recreation activities delivered by the Town of Canmore and/or other organization(s).    

ASSUMPTION OF RISKS
I am aware that Recreation Activities involve risks, dangers and hazards including the risk of serious personal injury. These risks, dangers and hazards include, but are not limited to: slips, trips and falls, cuts, abrasions; failure of equipment including ropes, harnesses, slings, anchor points, climbing holds, automatic belay systems, flotation devices, personal equipment, or any other equipment associated with or related to Recreation Activities; failing to engage in Recreation Activities safely or within one's own ability; loss of balance; overexertion or lack of fitness or conditioning; shock, stress or other injury to the body; defective, dangerous or unsafe condition of the facilities used for Recreation Activities; drowning, allergic reaction to chemicals used in the facilities; infectious disease contracted through viruses, bacteria, parasites, and fungi which may be transmitted through direct or indirect contact, unsafe actions of other facility users. I understand that I am responsible to inspect my child/ward's equipment and to ensure proper fit and its compatibility with Recreation Activities. I understand that should my child/ward choose not to wear a helmet that the risk of injury may be increased during certain Recreation Activities. I understand that negligence includes the failure on the part of the Releasees to take reasonable steps to safeguard warn or protect my child/ward from the risks, dangers, and hazards of Recreation Activities. Many of the Recreation Activities are unsupervised. I understand that it is my responsibility to learn about and understand the risks, dangers and hazards of participating in Recreation Activities and accept the risks associated with my child/ward's participation.

Guardian or Parent:


I AM AWARE OF THE RISKS, DANGERS AND HAZARDS ASSOCIATED WITH RECREATION ACTIVITIES (CLIMBING, FITNESS, ARENA ACTIVITIES AND OUTDOOR ACTIVITIES) AND I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM.

Guardian or Parent:


PERMISSION TO PARTICIPATE

In consideration of the Releasees allowing my child/ward to participate in Recreation Activities and permitting use of their climbing walls, fitness facilities, arenas, equipment and other facilities, and for other good and valuable consideration, I hereby agree as follows:

In entering into this Consent and Acknowledgement of Risk Agreement I am not relying on any oral or written representations or statements made by the Releasees with respect to the safety of Recreation Activities, other than what is set forth in this Consent and Acknowledgement of Risk Agreement.

I CONFIRM THAT I HAVE READ AND UNDERSTAND THIS AGREEMENT PRIOR TO SIGNING IT, AND I AM AWARE THAT I AM SIGNING THIS AGREEMENT OF MY OWN FREE WILL AND I ACKNOWLEDGE AND AGREE THAT I HAVE NOT BEEN COERCED OR PRESSURED BY THE RELEASEES TO EXECUTE SAME.

PLEASE NOTE THAT AS PART OF THE WAIVER COMPLETION PROCESS A PHOTO WILL BE TAKEN OF THE PERSON COMPLETING THE FORM AT THE ONSITE KIOSKS.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Gender*
Female
Male
Non-Disclosed
Other
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Information
Gender*
Female
Male
Non-Disclosed
Other
Third Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Information
Gender*
Female
Male
Non-Disclosed
Other
Fourth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Gender*
Female
Male
Non-Disclosed
Other
Fifth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Gender*
Female
Male
Non-Disclosed
Other
Sixth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Gender*
Female
Male
Non-Disclosed
Other
Seventh Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Gender*
Female
Male
Non-Disclosed
Other
Eighth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Gender*
Female
Male
Non-Disclosed
Other
Ninth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Gender*
Female
Male
Non-Disclosed
Other
Tenth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Gender*
Female
Male
Non-Disclosed
Other
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Custodial Groups: If you are planning to enjoy the climbing gym as a group activity you are required to make a booking by contacting Climbing@canmore.ca or the booking form at https://ntx.lv/3APcWQd . Examples of groups include: hockey teams, ski teams, youth groups, scouts.
Parent(s), Guardian(s) or Agent(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Gender*
Female
Male
Non-Disclosed
Other
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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