Consent to Receive Services
I, {name} (Parent/Guardian/Caregiver) of {fullName3} (Child/youth) consent to have my child receive services from the R-Gen International voluntarily and without coercion or undue influence. I understand that consent may be withheld, given or revoked by the client or guardian at any time. This consent will remain in effect for the duration of the service. I understand and agree to receive the services delivered as part of R-Gen International programs. Programming activities such as recreational activities and outings involve certain elements of risk. Injuries may occur while participating in these activities. The following list includes, but is not limited to, examples of the types of injury, which may result from participating in the above-mentioned activities.
1. Traffic Accident on the car or bus while being transported to and from activities.
2. Tripping, falling, or injuring themselves while participating in programs.
3. Food allergy/choking while eating snack or meals.
4. A drowning while participating in a swimming activity.
The risk of sustaining these types of injuries result from the nature of the activity and can occur without fault of either the participant, or R-Gen International, its employees/agents or the facility where the activity is taking place. By choosing to take part in the R-Gen International programs, you are accepting risk that you /your child may be injured. The chance of an injury occurring can be reduced by carefully always following instructions while engaged in program activities.
Transportation
I am aware that my child may use various modes of transportation while accessing Off-Site Activities within the Summer Day Camp program at R-Gen International and that staff to child ratios will be maintained during all off-site activities.
Consent to Receive Services and Release of Liability
Drop-in Facilities
Activity locations
· 2015 41 Ave SW, Edmonton, AB T6X 2T4
· 2755 119A St SW, Edmonton, AB T6W 3R3
Artwork, Photos and Video Recordings
I give permission for R-Gen International to display any work product, artwork, photos, and video recordings of the above-named child within the agency facilities, program spaces, websites, social media sites, and with media outlets for demonstrating impact, recognition and program promotion.
Release of Liability
I waive my legal rights against R-Gen International for any loss, injury or damage suffered during or by reason of participating in all events, programs and activities within the City of Edmonton and vicinity. I authorize the application of emergency medical attention and undertake to be responsible for any hospitalization, medical expenses and ambulance expenses.
Sunscreen Permission Form
I, {name}, the parent/guardian/caregiver of {fullName3} (child/youth), give permission to the employees/volunteers of R-Gen International Association to support and assist in the application of sunscreen on my child.
It is my responsibility to ensure my child has lotion sunscreen that I have sent and labelled with my child’s name on it. If my child does not have sunscreen (ie: runs out and/or forgot), the program may apply Sunscreen Lotion (SPF 50) to supplement.
I agree to the above statements and hereby declare that I am the legal parent/guardian/caregiver of the child/youth.