PARTICIPANT NAME:______________________________________________Age _____ [F | M] Contact:  phone (      ) _____________  fax (       ) _____________ e-mail ______________________ Activity:_________________________________________________________________________

 

Acknowledgement of Risk

"Play Radium Adventures"

Play Radium Registration:

RELEASE OF LIABILITY AND WAIVER

By signing this document I agree to waive certain legal rights, including the right to sue.

I,____________________ (parent or guardian) ___________________________________ (address) recognize that there are risks, dangers and hazards, inherent to outdoor recreational activities. I willingly accept and am fully responsible for any such risk, including the possibility of personal injury, death, property damage or loss, resulting there from. Any individual participating in negligence or liability activity will be informed of their behaviour and permission to contact the guardian will be required.

I, OR ( PARENT OR GUARDIAN) OF ______________________________ HAVE READ AND UNDERSTOOD this release of liability prior to signing it, and am aware that by signing this release of liability I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators, and assign may have against such releases.

SIGNED THIS________________________________DAY OF ________________________2002

SIGNATURE OF GUARDIAN, PARENT:______________________________________________

WITNESS: _______________________________________________________________________

 

For information contact the Radium Village office at (250) 347-6455
Volunteers welcome!!