POWER THROUGH PADDLING – DRAGON BOAT LEADERSHIP PROGRAM
REGISTRATION FORM
Full Name: ______
Address: ______
City: ______Postal Code: ______
E-mail Address: ______
Birth date: ______Age: ______Grade: ______School: ______
Parent/Guardian Name: ______
Parent/Guardian Number: ( )______Participant Cell Number: ( )______
Medical History (Please list any medical conditions that our staff should be aware of):
CCYAA Power Through Paddling “PTP” WAIVER AND RELEASE OF LIABILITY
In considering of being allowed to participate in any way in the CCYAA Power Through Paddling “PTP” athletic/sports program and related events and activities, the undersigned acknowledges, appreciates and agrees that:
1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk of serious injury does exist; and,
2. I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of Canadian Chinese Youth Athletics Association, referees, volunteers, agents and/or employees, other players or participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the Power Through Paddling “PTP” and any related events and/or activities (the “Releases*), and assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately, and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release and hold harmless the releases, with respect to any and all injury, disability, death, or loss or damage to person or property, whether caused by the negligence of the releases or otherwise.
5. I further agree to irrevocably grant the Canadian Chinese Youth Athletics Association, And their affiliates or assigns, the perpetual unlimited world-wide and royally free rights to record, reproduce, broadcast, exhibit, publish, sell, distribute or use in any way whatsoever, my name and likeness in any media, whether now known or hereafter developed, in connection with my attendance and participation in the CCYAA [Power Through Paddling “PTP”], including without limitation a videotape recording of such performance. I agree that I shall have no claim, title or interest in my attendance or participation or any materials produced hereunder.
6. I will adhere to the ‘CCYAA Fair Play Policy’ as stated on this form and follow the instructions as given by the on-site CCYAA representative.
CCYAA Fair Play Policy:
In accordance with CCYAA’s objectives to provide a safe and fun environment for its participants, individuals or groups who do not adhere to the following code of conduct when participating in CCYAA events will be subject to immediate suspension and have their conduct reviewed by the CCYAA Executive Rules Committee. Suspended members reserve the right for a scheduled appeal in the presence of the Committee.
- Fighting and un-sportsmen-like conduct (e.g. pushing, dangerous play, tripping, etc.) will not be tolerated. Upon the discretion of the CCYAA on-site representative, parties involved with this type of behaviour will be required to immediately leave the premises
- Any sort of racial / cultural / sexual based harassment will not be tolerated. This includes comments, visible material and/or gestures that the CCYAA on-site representative deems inappropriate
- Photography, videography or any sort of media recording devices must have disclosure and approval by CCYAA on-site representative for use
- Offensive language as deemed by the CCYAA on-site representative, will not be tolerated. CCYAA members engaging in this activity will receive a warning. If behaviour persists, that respective member will be required to leave the premises
- Participants are required to be fully clothed at all times. Changing of attire is required to be done inside changerooms / bathrooms only
- Information collected by CCYAA will not be provided to any external agencies and will be used STRICTLY as a means to update members on relevant CCYAA events / programs. Members can request to be removed from contact list.
- Any non CCYAA promotion / advertising on site without approval from CCYAA is strictly prohibited
- For liability purposes, individuals who are not registered members of CCYAA cannot be on the premises of a respective program
CCYAA members reserve the right to file a ‘letter of complaint’ regarding the CCYAA on-site representative, any other participants, the CCYAA and/or any of its affiliates to . CCYAA must respond to the complaint within five (5) working days upon receipt of the complaint
I have read this waiver and release of liability, fully understand its terms, understand that I have given up substantial rights by signing it, and sign it freely and voluntarily without any inducement
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF RESGITRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all Releases, and, for myself, my heirs, assigns and next of kin, I release and agree to indemnify the Releases from any and all liabilities to my minor child’s involvement or participation in the program as provided above.
Parent/Guardian Signature: ______Date: ______
CCYAA
| www.ccyaa.org | 60 Scottfield Drive, Scarborough Ont. M1S 5T7 | 416 845-8933 |