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To be read and signed by all PARTICIPANTS and by PARENTS/GUARDIANS of each PARTICIPANT under the age of 18

EVENT: Commerce Classic
EVENT DATE(S): March 6-7, 2020
EVENT LOCATION: Invista Centre, 1350 Gardiners Rd, Kingston, ON K7P 2Y2
Memorial Centre, 303 York St, Kingston, ON K7K 4M4
ORGANIZER: Cure Cancer Classic

PHOTOGRAPHIC RELEASE

I/We grant permission for images of the PARTICIPANT that may be captured during the EVENT (by video / photo / digital recording / etc.) to be used by the Cure Cancer Classic at Kingston, on its website, in is social media marketing, and in printed materials, for promotional purpose.

ELEMENTS OF RISK

Certain HAZARDS, DANGERS, and RISK of INJURY are inherent during this EVENT, which may be beyond the control of Organizers and Organizer’s Staff or volunteers at the EVENT; these may include injuries resulting from: failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment; being struck by other participants, spectators, equipment or vehicles; malfunctioning structures and equipment; vigorous physical exertion and strenuous cardiovascular activities; failure to follow directions from those in charge of the EVENT; and, loss of personal property (e.g. bags, other valuables).  The HAZARDS, DANGERS, and RISK of INJURY of this EVENT can include, but are not limited to those items set out in APPENDIX A to this Form.

DISCLAIMER

The organizer, along with his associated officers, directors, agents, contractors, employees, volunteers, members and representatives of the EVENT (all hereunder collectively referred to as “the Releasees”) are not responsible for any injury, death, loss or damage of any kind sustained by any person while participating in the activities/events as stated above (the “EVENT”) or in activities related to the EVENT including injury, loss or damage which might be caused by the Negligence of the Released Parties.

ALCOHOL AND/OR DRUGS POLICY

The PARTICIPANT, by initialing this section of the agreement, understands the risks associated with being under the influence of alcohol and/or drugs during the EVENT and agrees not to consume alcohol 6 hours prior to the EVENT or during the EVENT. Risks of consuming alcohol and/or drugs include, but are not limited to, dehydration, dizziness, poor judgment and lack of coordination; all of which may enhance the RISK OF ILLNESS OR INJURY. In addition, the PARTICIPANT agrees that it is his/her responsibility to adhere to the no alcohol and/or drugs policy at the EVENT. The organizer, along with his associated officers, directors, agents, contractors, employees, volunteers, members and representatives of the EVENT are not responsible for checking the players for signs of alcohol or drug consumption, and will not be held liable for any injury, death, damage or loss of any kind sustained by any person under the influence of alcohol or drugs (or the like) at the EVENT.

CONSENT TO PARTICIPATE***

I have read and understand the risks associated with participating in the EVENT and freely agree to participate in the EVENT and to voluntarily assume all risks, dangers and hazards resulting therefrom.  I understand that I am solely responsible for my own health, medical, dental, and property insurance. 

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY

In consideration of the Releasees allowing me or my child (as applicable) to voluntarily participate in the EVENT, I hereby agree as follows:

1. I RELEASE AND WAIVE as against the Released Parties any and all claims, demands, lawsuits, or actions of any other kind, for losses, liabilities, damages, injuries including death, costs, expenses including legal fees and disbursements, and any other liability of any kind including negligence, arising out of or in connection with my or my child’s (as applicable) participation in the EVENT as described above and in Appendix A.

2. I hereby indemnify and hold the Releasees harmless from any and all losses, liabilities, damages, injuries, claims, demands, lawsuits, costs, expenses including legal fees and disbursements, and any other liability of any kind including negligence, breach of contract or breach of any statutory or other duty of care, including any duty of care owed under the Occupiers Liability Act, RSO 1990 c.o.2., as amended, on the part of the Releasees, arising out of or in connection with my or my child’s (as applicable) voluntary participation in the EVENT.

3. This document is governed by the laws of the Province of Ontario and federal laws of Canada applicable therein. My agreement herein survives termination of my or my child’s participation (as applicable) in the EVENT. This document cannot be modified except in writing by the organizer and no oral modification or interpretation is valid.

4. My agreement enures to the benefit of and is binding upon me, my heirs, next of kin, executors, administrators, representatives, successors and assigns.

5. Acknowledgement:  By signing below, I am not relying upon any oral or written representations or statements made by the Releasees other than what is set forth in this document.

6. I HAVE READ AND UNDERSTOOD THIS DOCUMENT IN ITS ENTIRETY AND I AM AWARE THAT BY VOLUNTARILY SIGNING BELOW I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES.

Privacy: Personal information in connection with this form will be used for the purpose of administering your participation in the Event/event and related purposes. If you have any questions about the collection, use and disclosure of your personal information by the organizer, please contact the organizer at caroline.witzel@queensu.ca or 519-572-5633.

APPENDIX A
HAZARDS, DANGERS,
and RISK of INJURY inherent during this EVENT

Hazard: Risk

High physical activity: Hockey is an extremely fast-paced game, with injuries to the head (concussion), shoulders, elbows, wrists, back, hips, knees, or ankles possible.  Players are mandated to wear full protective equipment, including either a visor or full protective cage.  By wearing a half visor, players are aware of the possible risk of pucks, sticks or other players causing injury to their face.

Dehydration: Players will be playing high intensity sports.  There is a risk of dehydration, resulting in headaches, episodes of light headedness, fainting, chest discomfort, leg cramps, nausea and fatigue if inadequate amounts of water are consumed. Every PARTICIPANT should bring adequate water

ATHLETE CONCUSSION CODE OF CONDUCT

Queen’s Athletics & Recreation (A&R) is committed to the safety and well-being of the participants in our programs. Participation in sport programs and activities includes risk of injury that includes concussions. Concussions can pose a serious health risk with short and long term consequences if not recognized and handled appropriately. Sport Leaders have a significant role to play in concussion identification and management. In recognition of the potential seriousness of a concussion, ALL participants in A&R sanctioned programs are required to read and verify that they will adhere to the Athlete Concussion Code of Conduct as a mandatory condition prior to participation in any sanctioned activity.

I commit to following the concussion related protocols and expectations as highlighted below:

RECOGNIZE

I understand that a concussion is a serious head injury that can have short and long-term effects.

I Agree

I understand that any blow to the head, face, neck or body may cause jarring of the head and a concussion. 

I Agree

I understand that concussions can’t be seen, I might notice signs immediately or symptoms may occur hours or days afterwards. 

I Agree

REPORTING, REMOVAL FROM ACTIVITY & RETURN TO ACTIVITY

I will be honest and forthcoming about any signs and symptoms related to a concussion that I may be experiencing and report any injury to my Sport Leader. 

I Agree

I will report to my Sport Leader if another individual reveals they are experiencing concussion-like symptoms, or if I suspect another individual has sustained a concussion. 

I Agree

I understand I will not be able to return to play if I exhibit any signs/symptoms of a concussion and need to be cleared by a physician or qualified medical professional prior to returning to sport. 

I Agree

I commit to the return-to-sport process and established protocols. 

I Agree

RESPONSIBILITY

I will respect the roles and responsibilities of all Sport Leaders in “Removal from Sport” and “Return to Learn” and “Return to Sport” protocols. 

I Agree

I will properly wear the appropriate equipment for my activity at all times; and understand that equipment such as helmets and mouth guards may help, but are not guaranteed to prevent concussions. 

I Agree

I will help prevent concussions by committing to fair play and respect for all; respecting other athletes, coaches, team trainers and officials. 

I Agree

I commit to zero-tolerance for play that is considered high-risk for causing concussions 

I Agree

I understand that engaging in prohibited play, with high concussion risk, will be subject to mandatory expulsion from play; and that these consequences will increase with subsequent offences. 

I Agree

ACKNOWLEDGEMENTS

I have reviewed and commit to this Athlete Concussion Code of Conduct. 

I Agree

I understand that concussion education is a mandatory requirement of my participation in any Queen’s Athletics & Recreation sanctioned activity AND commit to reviewing the mandated A&R Concussion Education Resources prior to participating in any A&R sanctioned team/club and/or activities. 

I Agree

I understand that participation in sport and activity includes a risk of injury that includes concussion. I will not hold Queen’s University or its representatives responsible in the event of injury. 

I Agree

Definitions
“Concussion” is a brain injury. It can not be detected by X-ray, CT scan or MRI. It may affect the way a person thinks, feels and acts.
“Sport Leader” is any coach, instructor, offi cial, therapist, doctor, administrator and/or other individual who has responsibility for the organization of the sport activity.
“Return to learn/sport” are medically supervised processes/protocols that gradually introduce the injured athlete back to academics/activity to ensure they are fully recovered before they are exposed to full mental or physical tasks.

For more concussion information please visit Qsportsmedicine.ca

COACH CONCUSSION CODE OF CONDUCT

Queen’s Athletics & Recreation (A&R) is committed to the safety and well-being of the participants in our programs. Participation in sport programs and activities includes risk of injury that includes concussions. Concussions can pose a serious health risk with short and long term consequences if not recognized and handled appropriately. Sport Leaders have a significant role to play in concussion identification and management. In recognition of the potential seriousness of a concussion, ALL participants in A&R sanctioned programs are required to read and verify that they will adhere to the Coach Concussion Code of Conduct as a mandatory condition prior to participation in any sanctioned activity.

I commit to following the concussion related protocols and expectations as highlighted below: 

RECOGNIZE

I understand that a concussion is a serious head injury that can have short and long-term effects.  

I Agree

I understand that any blow to the head, face, neck or body may cause jarring of the head and a concussion.

I Agree

Any individual with a suspected concussion will be removed from activity immediately and seek the guidance of medical personnel. 

I Agree

I understand that concussions can’t be seen, symptoms may occur immediately or hours/days afterwards. 

I Agree

PREVENTION

I will require my athletes to wear the correct equipment properly; and respect the rules and officials. o I will commit to and require my athletes to play fair and respect the rules and their opponents. 

I Agree

RESPONSIBILITY

I commit to concussion recognition and reporting. This includes self-reporting of concussion and reporting to a Sport Leader when any individual is suspected of having sustained a concussion. 

I Agree

I will respect the roles and responsibilities of all Sport Leaders and physicians in the “Removal from Sport”, “Return to Learn” and “Return to Sport” protocols. 

I Agree

I will be approachable and provide opportunities before and after activity for athletes to discuss injury/concussion concerns. 

I Agree

I commit to zero-tolerance for play that is considered high-risk for causing concussions. 

I Agree

I understand that those that engage in prohibited play, with high concussion risk, will be subject to mandatory expulsion from play; and that these consequences will increase with subsequent offences. 

I Agree

ACKNOWLEDGEMENTS

I have reviewed and commit to this Coach Concussion Code of Conduct. 

I Agree

I understand that concussion education is a mandatory requirement of my participation in any Queen’s Athletics & Recreation sanctioned activity AND commit to reviewing the mandated A&R Concussion Education Resources prior to participating in any A&R sanctioned team/club and/or activities. 

I Agree

I understand the important role that I play in the concussion identification and management process and agree to support A&R established process and protocols. 

I Agree

Definitions
“Concussion” is a brain injury. It can not be detected by X-ray, CT scan or MRI. It may affect the way a person thinks, feels and acts.
“Sport Leader” is any coach, instructor, offi cial, therapist, doctor, administrator and/or other individual who has responsibility for the organization of the sport activity.
“Return to learn/sport” are medically supervised processes/protocols that gradually introduce the injured athlete back to academics/activity to ensure they are fully recovered before they are exposed to full mental or physical tasks.

For more concussion information please visit Qsportsmedicine.ca

A&R CONCUSSION INFORMATION SHEET

Queen’s Athletics & Recreation (A&R) is committed to the safety and well-being of the participants in our programs. Participation in sport programs and activities includes risk of injury that includes concussions. Concussions can pose a serious health risk with short and long term consequences if not recognized and handled appropriately. This “Information Sheet” provides a brief overview on the appropriate care for an individual with a concussion. Please take the time to review the material prior to participation in any sport related program and/or activity.

WHAT YOU NEED TO KNOW ABOUT CONCUSSION
There are four key steps in dealing with concussion to assist recovery from this injury: RECOGNIZE, RESPOND, MANAGE and RETURN TO LEARN/SPORT. This document provides an overview of each of the key steps, please visit Qsportsmedicine.ca for more information on concussion and treatment options.

RECOGNIZE
A concussion is the most common form of brain injury caused by an impact or forceful motion to the head or body that causes the brain to move inside the skull. Common causes of concussion include falls, motor vehicle crashes, and sport and recreational-related activities.

There is no way to know for certain whether a particular event will lead to a concussion—a relatively minor impact may result in a concussion while a higher-magnitude impact may not. It is important to note that if there is a history of concussion, even a minor impact or forceful motion can cause a concussion.

The Signs (observed in individual) and Symptoms (experienced by individual) consistent with concussion may include, but are not limited to:

  • Headaches
  • Neck pain
  • Dizziness or loss of balance
  • Nausea
  • Ringing in the ears
  • Blurred vision or seeing “stars”
  • Confusion or fogginess
  • Sensitivity to light or sound

Some symptoms may be delayed for hours or days after an injury and can include:

  • Frustration or irritability
  • Sadness
  • Fatigue
  • Concentration or memory issues
  • Anxiety or nervousness
  • Trouble sleeping

Concussion signs to watch for if you are a parent, camp counsellor or supervisor of pre-schoolers, may include:

  • Crankiness and irritability (beyond their usual)
  • Cannot be comforted or excessive crying
  • Sudden changes in nursing, eating, sleeping or playing patterns
  • Loss of balance, unsteady walking (more so than normal)
  • Lack of interest in favourite toys or activities
  • Listlessness or tiring easily
  • Loss of ability to carry on with newly acquired skills (across any social and emotional, language, physical development domains)

RESPOND: IMMEDIATELY
Following a potential concussion-causing event, the individual should be removed from activity and assessed for a medical emergency. This may require removing the athlete from the vicinity of the area of play/bench for a substantial period of time to accurately assess their condition. Queen’s A&R “Removal from Sport Protocol” can be found here.

If any of the Red Flags below are present, call 911 or seek immediate medical care. 

  • Neck pain or tenderness
  • Double vision
  • Weakness or tingling / numbeness / burning in arms or legs
  • Severe or increasing headache
  • Seizure or convulsion
  • Deteriorating conscious state
  • Vomiting
  • Increasingly restless, agitated or combative

Next steps: If not a medical emergency:

  • Do not leave the individual alone
  • Notify an emergency contact person
  • Continue to monitor for Red Flags and signs and symptoms of concussion
  • Do not let the individual return to their activity
  • Do not give the individual any immediate medication
  • Do not let the individual leave by themselves
  • Do not let the individual drive or ride a bike

WITHIN 48 HOURS:
The individual should be monitored before assuming that a concussion has not occurred, including monitoring throughout the night following the initial injury.

  • Do not wake the individual unless you have concerns about their breathing, changes in skin colour, or how they are sleeping.
  • Call 911 or seek immediate medical care if the individual is slow to wake or shows any of the Red Flags.
  • If any signs or symptoms are present, seek medical attention from a licensed medical professional such as a physician, nurse practitioner or Athletic Therapist.
  • If no signs or symptoms appear, the individual can return to normal activity while being monitored for several days. If no signs or symptoms appear, chances are that a concussion was not sustained. If unsure, see a medical professional for guidance.

MANAGE
A concussion can have a significant impact on physical, cognitive, and emotional functioning. The recovery process involves managing activities in order to not trigger or worsen symptoms—the key is finding the “sweet spot” between doing too much and too little. The recovery process is best approached in collaboration with key individuals, such as medical professionals, family members, friends, employers, teachers and school staff, and coaches.

WITHIN 48 HOURS:
The first and most important step in recovery from a concussion is to rest for a minimum of 2 days.
The individual will need both physical and cognitive rest in order to allow the brain to heal.

AFTER 48 HOURS:

  • Physical exertion should be limited to activities that do not result in an increased heart rate or breaking a sweat.
  • Restrict: physically strenuous work, exercise, sports, running, biking, rough play, etc.
  • Cognitive activity should be limited, minimizing activities that require concentration and learning.
  • Restrict: work or schoolwork, reading, electronics (computers, smartphones, video games, TV), musical instruments, loud music, etc.

It is important to understand that recovery is a fluctuating process. The individual may be doing well one day but not the next.

RETURN TO LEARN & RETURN TO SPORT
Symptoms should decrease over time, but some symptoms may return, worsen, or new symptoms may appear as new activity levels are introduced. If this happens, return to a lower level of activity that does not affect or bring on new symptoms. If you are worried that the individual is not improving, follow-up with a licensed medical professional, such as a physician, nurse practitioner or Athletic Therapist.

On average, it typically takes 2 to 4 weeks to recover from concussion. However, 15 to 30 percent will continue to experience persistent symptoms beyond this period. Persistent symptoms have the potential to cause long- term difficulties. If there is no improvement or symptoms are worsening 4-12 weeks after a concussion, physician referral to an interdisciplinary clinic, like Q Sports Medicine, is recommended.

Proper management of a concussion can reduce the risk of complications. Individuals returning from a concussion must successfully follow the “Return to Learn” and “Return to Sport” protocols and return to work or school before fully returning to sport and physical activities. The “Return to Sport Protocol” must include documented clearance by a physician before the athlete returns to full contact/intensity participation in their activities.

Q Sports Medicine has specific Return to Learn and Return to Sport protocols for Queen’s student-athletes that must be followed before athletes are medically cleared to return to training and competition.

Returning to full activity too soon may result in more severe symptoms or long-term problems. As well, returning to high-risk activities (contact sports, dangerous job duties) before full recovery and medical clearance can put the individual at risk of sustaining another concussion with more severe symptoms and a longer recovery period.

For more information on concussion education, identification and management please visit Qsportsmedicine.ca.

Today's Date: February 22, 2020

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I, the parent or legal guardian of Minor have read and understand the risks associated with the EVENT and hereby consent to my child’s participation in the EVENT and to his/her voluntary assumption all risks, dangers and hazards resulting therefrom. I understand that I am solely responsible for health, medical, dental, and property insurance covering my child.
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