Hoist Halifax Consent Form

Hoist Halifax Youth Consent Form

Hoist is a tech club for teens interested in coding, design or entrepreneurship. Hoist is held on the third Saturday of every month at Volta Labs.
Participant Information

A separate consent form is required for each participant.
Participant's Full Name*

First NameLast Name
Participant's Birth Date*

MonthDayYear
Participant's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Participant's Dietary Restrictions
Other restrictions or health conditions in which we should be made aware of?
Parent or Legal Guardian
Parent/ Guardian Full Name*

First NameLast Name
E-mail*
Home Phone Number*

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Emergency Contacts

If, in the event of an emergency, you're unable to be reached by the numbers listed above, the activity supervisor(s) have permission to attempt to contact the following emergency contacts.
Emergency Contact #1*

First NameLast Name
Relationship*
E-mail*
Home Phone Number

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Emergency Contact #2

First NameLast Name
Relationship
E-mail
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
I wish the above child to participate in the program HOIST organized by Volta Labs Incorporated (Volta).

I declare that if I am not the parent or guardian of the child(ren) I have authority from the above child’s parent or guardian to sign this Disclaimer.

I confirm that I do not know of any medical condition that the above child suffers from that has not been previously disclosed in this form and which might have the effect of making it more likely that any child be involved in an incident which could result in injury to themselves or others.

I acknowledge that the above child is responsible for their own safety and the safety of their possessions during the Event.

In the unlikely event of an accident involving the above child during the Event or any loss or damage to their personal effects, I acknowledge that the Company will not be liable for any direct or indirect loss, damage or injury arising from or in connection with the Event (except in the case of death or personal injury caused by the Company’s negligence). I agree to waive all and any claims against the Company in this respect of the above child.

As the guardian of the child I give consent to Volta to post pictures of the event online, and in other promotional materials, knowing the child may be in the pictures.

I acknowledge and confirm that I have read and understood the Disclaimer and I accept the terms contained therein.
I, the parent/guardian, hereby attest that I have carefully read this Permission to Participate, understand its contents, and agree to its terms and conditions.*

I agree
Date*

MonthDayYear
Signature*

Clear
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Hoist Halifax Youth Consent Form

Participant Information

Parent or Legal Guardian

Emergency Contacts