NYC Member's Name: ____________________________________________
Date of Birth ____day, ____month, ____year
If the NYC member is under the age of eighteen (18) the following portion must be also signed by a parent or guardian.
I, the undersigned NYC member and if applicable, his/her parent or guardian, understand and agree to attend and participate in the NYC meeting and Boys and Girls Clubs of Canada Atlantic Conference to be held at the Travelodge Hotel in Charlottetown, PEI, May 28 - 31, 1998. I am aware that while Boys and Girls Clubs of Canada, (BGCC), are covering the costs of my son/daughter/ward's travel, BGCC are assuming no responsibility for supervision of NYC members to or from the NYC meeting and Atlantic conference. I am aware that the NYC members will be sharing accommodation with another NYC member of the same gender. I am aware that NYC members may be in attendance at functions where alcoholic beverages are served, however, neither NYC members, regardless of age, or supervisory staff responsible for the NYC members, will be permitted to have alcoholic beverages at these functions or at any other time.
I, the undersigned NYC member and, if applicable, his/her parent or guardian, acknowledge and agree that participation in NYC activities by the NYC member shall be entirely at the NYC members's own risk. The NYC member's Club, (Member Club) the Member Club's Region (Region) and/or Boys and Girls Clubs of Canada, (BGCC), their staff or directors shall not be held responsible for any injuries, damage, or loss of personal property of any sort as a result of participation of the NYC member in NYC activities. Therefore in consideration of the Member Club, Region and BGCC (which I/we acknowledge as adequate consideration) the undersigned NYC member and/or NYC member's parent or guardian individually or as parent or guardian, release and forever discharge the member Club, Region and BGCC from all claims, demands, damages, actions or causes of action which may arise or result from the NYC member's participation in NYC activities, wether in law or in equity and which we our heirs, executors, administrators and assigns may have. I also give permission for the Member Club, Region and BGCC to use a visual reproduction (photograph, film, video, digital picture, etc.) of the NYC Member for publicity purposes connected with the promotion of the work of the Member Club, Region and/or BGCC.
The undersigned shall be responsible for the behaviour of the NYC member and shall indemnify the Member Club, Region and BGCC, it's successors and assigns, against all actions, damages, debts, accounts, claims, and demands which they have brought against it/them resulting from the participation my the NYC member in NYC activities.
_____________________________________
Signature of the NYC Member
____________________________________
Signature of Parent or Guardian
(required if NYC member is under 18 years)
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Signature of the Club Contact
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