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In order to participate in any events in Saskatoon hosted by Pure Witness Ministries this waiver form needs to be signed. It will be kept on record for the year until August 31st, 2024 and is used for all activities put on by Pure Witness in the Roman Catholic Diocese of Saskatoon.

You may sign up your entire family if you think different members may come to future events and it will be kept on record for the year.

Please note: A parent or Legal Guardian must sign for children under 18 years of age.

 

Definitions In this Agreement:

"Activities" includes all activities put on by Pure Witness Ministries in Saskatoon from September 1st, 2023 to August 31st, 2024, including preparation, planning and training, activities, services, use of facilities and transportation in any way related to activities. "Diocese" means Roman Catholic Diocese of Saskatoon, where these events are being held, including all parishes, organizations, associations, ministries and informal groups sponsored by, organized or carried out under the authority of the Diocese. "Facility" means the facility that the event is being held at.

 

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

For Participation in Pure Witness events in Saskatoon from September 1st, 2023 to August 31st, 2024.

READ THIS CAREFULLY

In consideration of being permitted to participate in the activities, and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I hereby agree as follows:

TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against the Diocese, facility, all Pure Witness Ministries employees, volunteers and organizers, and Pure Witness Ministries arising out of any aspect of my participation in Pure Witness activities.

TO RELEASE the Diocese, facility, all Pure Witness Ministries employees, volunteers and organizers, and Pure Witness Ministries from any loss, damage, expense or injury, including death, that I may suffer or that my next of kin may suffer during my participation in Pure Witness activities, due to any cause whatsoever, including negligence, breach of contract or breach of any statutory or other duty of care on the part of the Diocese or Pure Witness Ministries and also including failure on the part of the Diocese, facility, all Pure Witness Ministries employees, volunteers and organizers, or Pure Witness Ministries to safeguard or protect me from the risks, dangers and hazards referred to above; and

TO HOLD HARMLESS AND INDEMNIFY the Diocese, facility, all Pure Witness Ministries employees, volunteers and organizers, and Pure Witness Ministries from any and all liability for any property damage, personal injury, health risks to me or any third party resulting from my participation in Pure Witness activities.

TO PROVIDE NECESSARY MEDICAL TREATMENT, in the event that I am unavailable (parents/guardians), or unresponsive (adult participants), I do hereby give consent for all emergency medical care (including surgery, if deemed necessary and recommended by at least two attending physicians) prescribed by a duly licensed physician for my child/me in the event of injury or illness during any Pure Witness Ministries Events. This emergency medical care may be given under whatever conditions are deemed necessary, so as to preserve and protect life, limb, health and well-being of me/my child.

This Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity; this Agreement shall be governed by and interpreted in accordance with the laws of the Province of which the Pure Witness activities are held; and any litigation involving the parties to this Agreement shall be brought within the Province of which the Pure Witness activities are held.

In entering into this Agreement, I am not relying upon any oral or written representation or statements made by the Diocese, facility, all Pure Witness Ministries employees, volunteers and organizers, or Pure Witness Ministries with respect to the safety of Pure Witness activities, other than what is set forth in this Agreement.

I agree to allow my registration form to be released to Pure Witness Ministries knowing that Pure Witness Ministries will not sell or distribute my information to third parties without my permission.

I hereby consent to the collection and use of photographs and video footage at Pure Witness activities of my child (or self) for the purpose of promoting Pure Witness Ministries online and in print.

October 15, 2024



First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
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:*
Family Doctor Information

Please provide the NAME of your family doctor.

Please provide the PHONE NUMBER of your family doctor.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information and news about upcoming events by e-mail.
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.


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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Heath Card Number

Please provide your Provincial Health Card Number
Do you have any allergies? (medication, food etc.)*
No
Yes

If you checked yes above, please list your allergies below.
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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