THE JOURNALISM ALCHEMISTS CLUB

YOUTH FOR TRUTH JOURNALISM CLUB

Registration Form
The Journalism Alchemists Club is a hands-on, collaborative program designed for aspiring and practicing storytellers, young folks who are curious about their community and curious about exploring what we traditionally consider journalism and transitioning to new ways of truth telling in Thames Centre.

Age: 13+ years old

Location: Dorchester Flight exec Centre - Blueline Room

Duration: wednesday, October 22, 2025 - December 10, 2025

Time: 5:00-7:00 PM

Dates:

October: 22, 29
November: 5,12,19,26
December: 3,10

Cost: FREE!

Questions: Contact WHITNEY BROWN at wbrown@bgclondon.ca

Participant's Information
Participant's Name*

First NameLast Name
Participant's Date of Birth*

MonthDayYear
Date
Participant's age*
Does the participant have any medical conditions we should be aware of?*

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Are there any medications the participant is taking we should be aware of? (Including inhalers, insulin pumps, etc.)*

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Guardian 1 / Parent 1 Name*

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Guardian 2 / Parent 2 Name

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Address*

Street Address

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Primary Phone*
Secondary Phone
E-mail*
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Emergency Contact Information
Emergency Contact's Name*

First NameLast Name
Relationship to Participant*
Relationship to Participant
Phone Number*

Waiver
BGC LONDON (BOYS & GIRLS CLUB OF LONDON)

RELEASE OF LIABILITY, WAIVER OF CLAIMS

ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT.

BY SIGNING THIS AGREEMENT YOU WILL WAIVE CERTAIN

LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE

PLEASE READ CAREFULLY!
Parents/Guardians - Type your initials here to indicate you have read the box above.*
TO: Boys & Girls Club of London and the Boys & Girls Club of London Foundation (together the “BGCL”) and their directors, officers, employees, instructors, agents, representatives, volunteers, independent contractors, subcontractors, sponsors, successors and assigns (hereinafter collectively referred to as the “Releasees”).

COVID – 19 COVID-19 is a contagious disease (“Covid”). We care about you, your family, our employees and the public. We strive to obey the law and follow Covid guidelines and implement all risk mitigation measures. However there are significant health risks and high risk of transmission through physical or shared contact. COVID-19 is novel and, because it can be transmitted through physical or shared contact with another person, the risk of contraction from engaging in sport activities may be foreseeable.

ASSUMPTION OF RISKS

I am aware that the activities at the BGCL programs involve risks and dangers that may cause serious injury and even death, and loss or damage to personal property. These risks are inherent in the activities and cannot be eliminated without altering their character and value. The risks include, among others, the following: contracting Covid; moving about the BGCL premises; negligence on the part of myself and/or other participants; negligence of the BGCL and its staff, including the improper use of equipment; the breakage and failure of equipment and structures; over exertion, together with other risks which may be encountered and NEGLIGENCE ON THE PART OF THE RELEASEES, INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE.

The BGCL programs are designed for use by participants of average strength, mobility and fitness who are in good health. Several medical
conditions, including but not limited to obesity, high blood pressure, cardiac and coronary artery disease, pulmonary problems, arthritis, tendonitis, or joint and muscular-skeletal problems may impair the safety and well being of participants as may other medical, physical, psychological or psychiatric problems. All such medical conditions may increase the risk of participating in the programs and cause the participant to be a danger to themselves or others. Participants with underlying medical, physical, psychological or psychiatric conditions must evaluate their condition and their ability before choosing to participate in the programs. All participants must inform BGCL in writing of any such medical, physical, psychological or psychiatric conditions before participating in any programs. The Releasees reserve the right to prevent any person, for medical or safety reasons, from participating in the programs at any time.

I AM AWARE OF THE RISKS, DANGERS AND HAZARDS ASSOCIATED WITH MY USE OF THE BGCL PROGRAMS AND I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE AND LOSS RESULTING THEREFROM.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

In consideration of the Releasees permitting my use of the BGCL PROGRAMS and other facilities at the BGCL (hereinafter referred to as “the BGCL Facilities”), I hereby agree as follows:
1. TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against the RELEASEES, and TO RELEASE THE RELEASEES from any and all liability for any loss, damage, expense or injury including death that I may suffer, or that my next of kin may suffer resulting from either my use of or my presence at or on the BGCL Facilities DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE UNDER THE OCCUPIERS LIABILITY ACT, RSO 1990, c.02 ON THE PART OF THE RELEASEES, AND ALSO INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE;
1. 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 use of or presence on the BGCL facilities.
I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.

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Additional Permissions
MEDIA CONSENT

BGCL reserve the right and permission to publish, reproduce, distribute and/or otherwise use any still or moving photograph, for such purposes and with such frequency as it shall determine in its sole discretion without further compensation or consideration to me and without further authorization by me for, yet, unnamed video or photographic projects (including promotion, marketing and social media) which shall constitute the sole property of BGCL. BGCL shall be released from and against all liability resulting from its use of the photos or related to my use of the product.
I have read and understand the Photo Consent Release*

I do give permission to use my child's likeness.I DO NOT give permission to use my child's likeness.
Full Name of Parent/Guardian*

First NameLast Name
Confirmation E-mail*
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Signature*

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Date and Time Signed

MonthDayYear
Date
Hour MinutesAM/PM Option
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ASSUMPTION OF RISKS

MEDIA CONSENT