Hiking Volunteer Registration Form

NOTE: You can book one kayaking shift and one paddleboarding shift, however, AVOID scheduling them back-to-back. Allow time for transferring between the kayak and the paddleboard.

BCMOS KAYAKING:

BCMOS PADDLEBOARDING:

Name

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityProvince

Postal / Zip Code

Phone (Home)

Please enter a valid phone number.Format: (000) 000-0000.

Work Number

Please enter a valid phone number.Format: (000) 000-0000.

Cellphone Number

Please enter a valid phone number.Format: (000) 000-0000.

Preferred E-mail

WE MAKE ALL PROGRAM UPDATES VIA EMAIL

Date of birth

Nature of Disability

Mobility Aids

Medications

Allergies

Please provide two emergency contacts:

Rows	Name	Phone Number	Relationship
1.
2.

Do you know anyone interested in volunteering with BCMOS?

WRITE NAME, EMAIL ADDRESS AND PHONE NUMBER

Participant's Release of Liability, Waiver of Claims, Medical Waiver, Assumptions of Risks and Indemnity and Image Consent

By signing this document, you will waive certain legal rights including the right to sue. Please read carefully.

ASSUMPTION OF RISKS

I AM AWARE THAT THERE IS POTENTIAL RISK FOR PERSONAL INJURY INVOLVED IN ANY PHYSICAL ACTIVITY . I freely accept and fully assume all such risks, dangers and hazards, including the possibility of personal injury (including but not limited to: bumps, bruises, cuts, scrapes, concussion, broken bones, infections, abrasions, hypothermia, death and/or property loss resulting from my participation in this BCMOS activity.

I am also aware that I should discuss my participation in this activity with my physician to determine the effect on my current health.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In consideration of approval to participate in BCMOS activities, I hereby agree as follows:

INITIAL* TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against DF, it’s directors, officers, employees, volunteers, representatives, other volunteers and partner organizations (Disability Foundation and it’s affiliated societies, organization partners, and government entities) all of whom are hereinafter collectively referred to as “ The Releases”;

INITIAL* TO RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense that I suffer, or my next of kin may suffer as a result of my participation in this activity due to any cause whatsoever INCLUDING NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE. I acknowledge my responsibility to ensure adequate medical, personal health, dental and accident insurance coverage, as well as protection of my personal possessions;

INITIAL* TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to property of, or personal injury to, any third party resulting from my participation in DF activities;

INITIAL* 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;

INITIAL* In entering into this Agreement, I am not relying upon any oral or written representations or statements made by the Releases other than what is set forth in this Agreement;

INITIAL* I grant permission to BCMOS and/or their designates to proceed in any manner they deem necessary in the case of a medical emergency involving myself. I am releasing the right for this information to be shared with DF volunteers, staff, and/or medical staff who are in contact or responsible for my (or my child/ward’s) participation in the program;

INITIAL* BCMOS and/or their designates often take photographs/videos of volunteers and staff while programs are operating. These pictures may be used for promotional purposes, training and public education. I give my permission for photographs/videos to be taken of myself/ my child/ward, and for these to be subsequently published.

I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT BELOW I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES.

By typing your FULL NAME, you have read and agreed to all the terms and conditions in this application.

Participant's Signature

Sign-up Date:

Consent of Parent/Guardian (Type your full name)

If participant is under 19 years old.

IF YOU ARE SIGNING FOR SOMEONE 19 YEARS OF AGE OR OLDER, DO YOU HAVE LEGAL COMMITTEESHIP or a REPRESENTATION AGREEMENT IN PLACE?

YES/NOanswer here TYPE FULL NAME answer here

Please indicate the program you would like to participate.

Additional Information or Comments:

Hiking Volunteer Registration Form

Reserve your spot for the program you would like to participate.

Participant Information

Volunteer Information

Medical Information

Emergency Contacts