NATURE OF ACTIVITIES: Catholic faith formation, Rock Wall, High Ropes, Canoeing, Archery, Campfire, Volleyball, Soccer and other sports activities.
ACTIVITY SUPERVISOR(S): Nazneen Duarte, Elizabeth Noronha, Esterina Sharkey, Fr. Jerek Scherber along with other certified adult volunteers of the club.
TRANSPORTATION: Not Applicable. Participants are responsible for securing their own transportation to and from Camp Brebeuf as Legion of Christ Canada Inc and Challenge clubs do not provide transportation.
REQUIREMENTS: The child named above is in good health and has no physical or medical limitations that would cause the activities as described above to be detrimental or dangerous to the child. Parents/guardians should specify allergies and medical problems in emergencies section above.
CONSENT: I/We hereby consent to the above-named child's participation in the activities described above, and specifically request that she be allowed to participate in those activities. I/We warrant that I/we have full authority to legally consent to her participation in the activities described on this form, and all provisions contained herein.
AUTHORIZATION: I/We hereby authorize Legion of Christ Canada, Inc. and Challenge clubs to use the image and likeness of my/our child in photograph or video form whether taken by or commissioned by Legion of Christ Canada, Inc. and Challenge Clubs in their promotional materials and for their promotional purposes associated with their non-profit activities. This authorization shall extend to use of my/our child’s image and likeness on the website of Legion of Christ Canada, Inc. and Challenge clubs or its successor in operation or affiliated organization(s) upon written consent of Legion of Christ Canada, Inc. and Challenge Clubs. I/We understand that this authorization shall survive the end of my/our child’s participation in the activities referenced on this form.
INSURANCE: I/We understand that Legion of Christ Canada, Inc. and Challenge Clubs do not carry any insurance relative to the activities or for any injury that may occur to the above-named child. I/We represent that the child is (a) covered by insurance through my/our own insurance carrier; or (b) that I/we am/are personally financially responsible for any and all medical costs incurred as a result of the child's injury.
MENTORING: Participants may be offered mentoring, which is intended to help young people personalize the principles of Christian living that they receive at home and in retreat activities. Mentoring involves a private conversation with an adult conducted in plain view of others. When dealing with adolescents, confidentially will be maintained to foster openness of dialogue, but situations involving sexual abuse of a minor or threats to life or physical health will be reported to the appropriate authority and to the parents (except in those cases where the parent may be the alleged abuser).
EMERGENCIES: If the above-named child requires any emergency medical procedures or treatments during the activities, I/We consent to the activity supervisor(s) taking, arranging for or consenting to such procedures or treatments in the discretion of the activity supervisor(s). For purposes of such procedures and treatments, my/our child's blood type is above and my/our child has the following allergies or other medical problems (if any) as above.
EMERGENCY CONTACTS: If, in the event of a medical or other emergency, I/we am/are unable to be reached by telephone at my/our home or work telephone numbers listed below, I/we authorize the activity supervisor(s) to attempt to contact me/us through the emergency contacts listed below: