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613 600-1607

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    Choice of program
    Does your child have any medical issues or allergies? If yes, please explain
    Does your child have a special need? If yes, please explain.
    I give my permission to take my child to the hospital or doctor in case of emergency
    I give permission to allow my child to receive medical treatment either by way of first aid by an appropriately qualified person, either by a doctor at the hospital or wherever he goes.
    Relationship to participant:
    All reasonable steps will be taken to contact the parent(s), guardian(s) immediately in the eventemergency

    Risk assumption:

    I understand the risks inherent in physical activity. On behalf of the child in my care, I accept these risks and
    I agree to participate in the program listed above. I waive any legal proceedings on my part or on behalf
    of persons acting on my behalf against the organizers and their staff, for any damages or other
    inconvenience my child has while participating in the program or traveling to and from the program.

    Address of the field: Louis Riel Dome, 1659 Bearbrook Rd, Gloucester
    Payment options: $150 per participant