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Camp Waiver

Off-Site Permission

I hereby give my permission for my son/daughter to go on excursions off site. I understand that my son/daughter may walk to a destination. 

Photography Release

I hereby grant and release to Canlan Ice Sports, the right to use photographs, audio tapes, and/or videotapes in which I and/ or my children appear in any materials such as videos, films, recordings, still photographs or articles relating to Canlan Ice Sports, its programs and services including, but not limited to, brochures, newsletters, annual reports or our Web site, whether broadcast on television, radio or any other medium. 

Camp Release and Waiver of Liability

  1. The participant assumes all risk of personal injury which may result from participation in the Canlan Ice Sports Camp
  2. All Canlan Ice Sports camps require full equipment
  3. In all soccer camps proper fitting shin guards and full soccer socks to cover are mandatory
  4. The participant will not hold Canlan Ice Sports, any of the officials or staff liable for injury which the player may sustain while participating in camp activities
  5. The participant understands and agrees that all sports and activities at camp have physical dangers which may result in serious injury or death
  6. The participant is advised to carry additional medical insurance
  7. The participant certifies that he/she has no known medical condition which would prohibit him/her from participating in the camp
  8. The participant agrees that he/she will act in a responsible manner in all Canlan Camp activities
  9. The participant agrees to reimburse Canlan Ice Sports, in full within 5 days of notice, for the cost of any property damage for which the player is held responsible by the Canlan Ice Sports Staff, Management or officials.
  10. Individuals who participate in the Canlan Camps understand that Canlan Ice Sports and Canlan Ice Sports Corp. shall not be held responsible in any way for any accident or injury of medical expense incurred as a result of his/her participation in the Canlan Camp.
  11. Canlan Ice Sports is not responsible for any stolen, damaged or lost articles.
  12. Canlan collects and uses personal information in line with the 10 Privacy Principles. By providing us with your information, you consent to Canlan’s use of this information surrounding pertinent information for the product or service you are enrolled in. For more information, ask for a copy of our brochure: Protecting Personal Information & Privacy Makes Good Sense or visit our website at www.icesports.com
  13. As a participant of this Canlan Camp, I understand and will abide by all the terms and conditions

Please read carefully and initial inside each box to indicate you have read and understood the above statements:

Parent/ Guardian Information section completed and accurate

I have read and consent to the “Off Site Permission” statement above

Authorized pick up information section completed and accurate

I have read and consent to the “Photography Release” statement above

Camper’s medical information and history section completed and accurate

I have read and consent to the Camp Release and Waiver of Liability 

I authorize staff to administer Epinephrine in the event of an anaphylactic reaction 

Today's Date: January 15, 2019

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive future emails from Canlan Ice Sports Corp. regarding their products, services, sales and special events
Parent / Guardian Information

#1: Parent/ Guardian Full Name: *
Relationship:*

Home Phone: *

Work Phone: *

Cell Phone: *

#2 (Optional) : Parent/ Guardian Full Name:
Please Select

Home Phone:

Work Phone:

Cell Phone:
Authorized Pick Up Designation

List the full name (s) and phone number of persons authorized to pick up your child below:


Name:

Relationship:

Phone:

Cell Phone:

Name:

Relationship:

Phone:

Cell Phone:
Emergency Contact Information

Name *

Relationship *

Home Phone *

Work Phone *

Name

Relationship

Home Phone

Work Phone

Name

Relationship

Home Phone

Work Phone
Parent(s) or court-appointed legal guardian(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.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Camp Attending: *

Camp Week: *

Medical Information


My child has the following allergies, or pre-existing illness/health concern (s). Please indicate if an Epipen is required and/or carried by the camper...

My child is on the following medications:
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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