Young Adults Social Registration Form

Young Adults Social Registration Form
Today's Date

DayMonthYear
Date
Personal Information
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Days
Age
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Name*

First NameLast Name
Relationship*
Example: Mother, Uncle, etc.
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Information
Are you a student?*

YesNo
Are you working?

YesNo
What is your status in Canada?
How long have you been in Canada?*
What is your home language?*
Are you/your family a client of VDICSS?*

YesNoNot sure
Would you like further information about VDICSS?

YesNo
Do you have any allergies/dietary requirements?*
Do you have any medical conditions that we need to be aware of?*
Participant Signature*

Powered by Jotform SignClear

WAIVER
ASSUMPTION OF RISK, RELEASE, WAIVER OF CLAIM AND INDEMNITY

NOTICE: THIS DOCUMENT AFFECTS LEGAL RIGHTS, INCLUDING YOUR RIGHT TO SUE, AND CREATES LEGAL RESPONSIBILITIES. PLEASE READ CAREFULLY. TO: All clients, volunteers, society members, Board of Directors of Vernon & District Immigrant and Community Services Society (VDICSS) I agree as follows:
1. ASSUMPTION OF RISK

I ACKNOWLEDGE AND AGREE that participation in the VDICSS Event involves potential dangers, risks and hazards. I FURTHER ACKNOWLEDGE AND AGREE THAT my participation in the VDICSS Event is entirely at my own risk and that I freely accept all the inherent risks of participating in the VDICSS Event and the possibility of personal injury, death, assault, property damage and loss resulting there from. I FURTHER ACKNOWLEDGE AND AGREE THAT VDICSS' acceptance of my involvement as a participant in the VDICSS Event does not and will not make me an agent, contractor, employee, or partner of VDICSS.
2. RELEASE AND WAIVER OF CLAIM

I WAIVE ANY AND ALL claims I may now, and in the future, have against, and release and discharge from all liability, and agree not to sue, VDICSS, its officers, employees, agents, representatives, and each of them and their respective agents, administrators, representatives, heirs, successors and assigns (the "Releasees"), with respect to any and all liability, costs (including legal costs), claims, damages, demands, actions, and causes of action of whatever kind which might arise from or in connection with my participation in the VDICSS Event including, without limitation, any personal mental or physical injury, illness, death, property damage, loss of personal freedom or financial loss or other loss suffered by me or any other family members or dependents, arising, directly or indirectly, from my participation in the VDICSS Event, whether foreseen or unforeseen and regardless of the cause thereof including, without limitation, negligence, or partial negligence on the part of the Releasees or any of them.
3. INDEMNITY

I AGREE to hold harmless and to indemnify the Releasees for any and all claims made against any of the Releasees by any person, including any claim or action by or on behalf of my spouse or dependents (present or future), for damages suffered or costs incurred arising out of or related to any aspect of my participation in the VDICSS Event, including, without limitation, any of the matters described or contemplated at item 2 above.
4. UNDERSTANDING

I DECLARE that I fully understand the terms of this Agreement and that I have not been influenced by any representations or statements made by or on behalf of VDICSS not recorded herein. I CONFIRM THAT I am the full age of 18 years and I have read and understood this Agreement prior to signing it and I agree that the legal rights and obligations under this Agreement will be binding upon my heirs, next-of-kin, executors, administrators, and successors. I am aware that by signing this Agreement I am releasing and waiving certain legal rights, including the right to sue and to be awarded potentially substantial damages, which I or my heirs, next-of-kin, executors, administrators, and assigns have or may have against the Releasees.
5. RELEASE OF PHOTOS

I AGREE that I give permission for VDICSS to take photos of my child/myself during VDICSS activities and programs and CONFIRM that I understand that these photos may be used on VDICSS social media, website and/or marketing material.
6. JURISDICTION

I AGREE that this Agreement shall be governed in all respects by and interpreted in accordance with the laws of the Province of British Columbia.
Participant Signature*

Powered by Jotform SignClear
CODE OF CONDUCT FOR VDICSS YOUNG ADULTS

This Code of Conduct is for the benefit and protection of all involved in the Vernon and District Immigrant and Community Services Society (VDICSS) Young Adult program.
As a VDICSS young adult participant, you understand and agree that you will not initiate, support or participate in behavior that can be considered Harassment, Discrimination and/or Violence. Examples of expected behavior include:
• Treating everyone with respect and fairness.
• Do not engage in any form of harassment, discrimination, or violence.
• Discrimination means treating someone unfairly based on factors like race,
gender identity, disability, sexual orientation, religion, or other protected
characteristics.
• Harassment includes making offensive comments, sharing offensive materials,
humiliating or teasing others based on their protected characteristics, or
engaging in unwelcome behavior.
• Sexual and gender-based harassment includes inappropriate comments, physical
contact, offensive jokes, or unwanted advances.
• Avoid making unwelcome sexual solicitations or advances, and report any such
behavior.
• A poisoned environment is created when comments or conduct create a
discriminatory atmosphere, even if they are not directed at a specific person.
• Violence includes physical attacks, threatening behavior, or verbal/written
threats that could cause harm.
• Silence or appearing to go along with harassment does not make it acceptable.
• VDICSS has zero tolerance for harassment, discrimination, or violence among
staff, volunteers, and program partcipants.
• VDICSS may reject applications or remove individuals from the program for
engaging in such behavior.
• If you experience any behavior that goes against this policy, report it to VDICSS
staff immediately.

I understand that my participation in the VDICSS Young Adult program is conditional upon my compliance with this Code of Conduct.
Participant Signature*

Powered by Jotform SignClear
Should be Empty:

Young Adults Social Registration Form

Personal Information

Emergency Contact

Additional Information

WAIVER

ASSUMPTION OF RISK, RELEASE, WAIVER OF CLAIM AND INDEMNITY

1. ASSUMPTION OF RISK

2. RELEASE AND WAIVER OF CLAIM

3. INDEMNITY

4. UNDERSTANDING

5. RELEASE OF PHOTOS

6. JURISDICTION

CODE OF CONDUCT FOR VDICSS YOUNG ADULTS

As a VDICSS young adult participant, you understand and agree that you will not initiate, support or participate in behavior that can be considered Harassment, Discrimination and/or Violence. Examples of expected behavior include: