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Revive: Discovering Our Past, Strengthening Our Future Youth Program
October 8, 2024
-
June 17, 2025
«
RCIC Boys Boxing 2024-2025
RCIC Karate Class 2024-2025
»
Revive: Discovering Our Past, Strengthening Our Future Youth Program
Age
(Required)
Please enter a number from
14
to
18
.
Must be between 14 and 18 years old to join.
Student First Name
(Required)
Student Last Name
(Required)
Parent First Name
(Required)
Parent Last Name
(Required)
Email
(Required)
Phone Number
(Required)
Medical conditions
Please list any of the students medical conditions (Leave blank if there are none).
Address
(Required)
Street Address
City
State / Province / Region
Consent
(Required)
To the best of my knowledge, my child is in good physical condition and fully able to participate in this program. I am fully aware of the risks and hazards connected with the participation in sports tournaments, games, and character refinement activities, including physical injury or even death, and hereby elect to voluntarily allow my child to participate in said event, knowing that the associated physical activity may be hazardous to my child and their property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by my child, or loss or damage to property owned by my child, as a result of participation in this program.
I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, Rose City Islamic Center and any of their employees or volunteers (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child, or to any property belonging to my child, while participating in physical activities, or while on or upon the premises where the event is being conducted.
It is my expressed intent that this release and hold harmless agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns, and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVE, DISCHARGE, and COVENANT TO SUE the above-named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the province of Ontario.
In confirming this release, I acknowledge and represent that I HAVE READ THE FOREGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT, AND CONFIRM IT VOLUNTARILY as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.
I agree to all outlined in the above Liability waiver.
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Start:
October 8
End:
June 17, 2025
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