Informed Consent and Acknowledgement
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I hereby give my approval for my child’s participation in any and all activities prepared by {Organization} during the selected camp. In exchange for the acceptance of said child’s candidacy by {Organization} ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless {Organization} . and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected
camp sessions.
In case of injury to said child, I hereby waive all claims against {Organization} . including all Directors, Leaders and Volunteers, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities, including physical exercise. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization
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As Parent and/or Guardian of the named child, I hereby authorize the diagnosis and treatment by a
qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which
in the opinion of the attending medical professional, requires immediate attention to prevent further
endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain,
suffering or discomfort, if delayed.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical
treatment, x-ray examination and immunizations for the named chold. In the event of an emergency arising
out of serious illness, the need for major surgery, or significant accidental injury, I understand that every
attempt will be made by the attending physician to contact me in the most expeditious way possible. This
authorization is granted only after a reasonable effort has been made to reach me.
Permission is also granted to the {Organization} . and its affiliates including Directors, Leaders, and
Volunteers to provide the needed emergency treatment prior to the child’s admission to the medical
facility.
Release authorized on the dates and/or duration of the registered season.
This release is authorized and executed of my own free will, with the sole purpose of authorizing medical
treatment under emergency circumstances, for the protection of life and limb of the named minor child, in
my absence.
PAYMENT​
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Please send payment of $55.00CAD by e-transfer to the following email:
treasurer@agincourtbc.net
Note: Payment for Camp Agincourt 2025
CONFIRMATION
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BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Thank you for registering to our camp. We can't wait to see you!
