Active Energizers Information Form

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CONTACT INFORMATION

MEMBERSHIP

Member

Non-Member

Member barcode #

Today's Date

Child's Name *

Child's Birthdate *

Address *

Postal Code *

Email Address *

Parent/Guardian's Name(s) *

Cell Phone Numbers *

Alternative Pick up Information

Will your child be coming with support?

Yes

HEALTH INFORMATION

Child's Doctors Name, Phone Number & Address *

Are Immunizations up to date?

Yes

Does your child have allergies?

Yes

Please indicate allergies, reactions and medications below:

Does your Child have any exceptional medical needs? ie. Diabetes, Asthma, etc. If yes, you will be given a care plan to complete for our records.

Yes

Do we have permission to take your child outside? (weather permitting and on MNPCSC property)

Yes

What Program is your child registered in?

Active Energizers January

Active Energizers March

WAIVER FORM

In consideration for permission, granted now or in the future by MNP Community & Sport Centre and Lindsay Park Sports Society (LPSS) for the Participant to participate in Active Living Program(s) Sept 2020 – November 2020.

I/we, as the parent(s)/guardian(s) of the Participant agree and acknowledge that:

The Participant has met all of the prerequisites required for participation in the activity(s).

1. The Participant will abide by the rules and regulations imposed on the participants in the activity(s).

2. There are risks and hazards inherent in the very nature of the activity(s) and that as a result of these risks and hazards, the Participant, may suffer personal injury, even death, as well as property loss. Depending on the Camp, activity(s) may include: badminton, baseball, circuit and strength training, dance, diving, floatables, gym and outdoor games and sports, gymnastics, indoor cycling, nutrition education, obstacle courses, running, swimming, trampolines, yoga, bouncy castle and outdoor skate park. I am aware and understand the risks and hazards associated with the activity(s) and may be present in the activity(s) and that the Participant is assuming the risks and hazards at his or her own risk.

3. I waive any claim the Participant or I may have against MNP Community & Sport Centre and Lindsay Park Sports Society (LPSS) and any and all instructors, coaches and organizers of the activity(s) and their respective heirs, representatives, successors and assigns from all claims, demands, costs, expenses, actions and causes of action arising from the Participant's involvement in the activity(s) and agree to indemnify and hold harmless the City of Calgary for any claim, including any claim for medical services arising from the Participant's involvement in the activity(s).

4. MNP Community & Sport Centre and Lindsay Park Sports Society (LPSS) may secure such medical advice and services as it, in its sole discretion, may deem necessary for the Participant's health and safety and I shall be financially responsible for such advice and services. I understand that MNP Community & Sport Centre and Lindsay Park Sports Society (LPSS) do not provide accidental death, disability, dismemberment or medical expense insurance on behalf of the participants in the activity(s) and therefore agree to assume responsibility for such insurance coverage for the Participant.

5. I agree that in the event that any provision of this form is held to be invalid and unenforceable by any court of competent jurisdiction, the invalidity or unenforceability of such provision will not affect the remaining provisions of this form, which shall continue to be enforceable.

I HEREBY ACKNOWLEDGE READING, UNDERSTANDING AND AGREEING WITH THE FOREGOING.

I AGREE to the above Waiver Forms Terms and conditions

I DISAGREE to the above Waiver Forms Terms and conditions

Full name of Parent/ Guardian permitting Waiver Form Terms and Conditions

IMAGE RELEASE

My child has permission to participate in media coverage and photographs of camps, which may be taken for media or marketing purposes at MNP Community & Sport Centre. I hereby grant MNP Community & Sport Centre the right and permission to publish moving composite reproductions for the purpose of, without limitation, television, publications, and any trade or advertising purposes. Accordingly, I release and discharge MNP Community & Sport Centre & Lindsay Park Sport Society (LPSS) from nay liability by virtue of blurring, distortion, alteration, optical illusion or use in composite form that may occur or be produced in taking of said picture(s) or any processing through completion of the finished product.

IMAGE RELEASE AGREEMENT

I AGREE to the above Release Forms Terms and conditions

I DISAGREE to the above Release Forms Terms and conditions

Full name of Parent/ Guardian permitting Image Release Form Terms and Conditions

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MNP Community & Sport Centre

2225 MacLeod Trail SE
Calgary, Alberta T2G 5B6
403.233.8393
info@mnpcentre.com

Hours of Operation
Monday-Friday: 5am-11pm
(Pools close at 10pm M-F)
Saturday: 6am-10pm
Sunday: 7am-10pm
Stat. Holidays: 7am-6pm

There are no Group Fitness or Registered
Programs on statutory holidays.

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