Youth Release & Waiver of Liability Form

I/we have read, and am willing to accept the Objectives of the Burnaby Neighborhood House (B.N.H). Leadership Program as described on the program package. I/we agree that our son/daughter will follow all reasonable instructions and directions of the coordinator and instructors duly appointed by Burnaby Neighbourhood House Society (B.N.H.). I/we understand the risks and description of activities associated with the Youth Leadership Programs.  I/we hereby release, remise and forever discharge B.N.H. its agents or volunteers of and from all manners of action, claims and loss or expense sustained, arising out of or in any way connected with participation in any program or attendance at any location operated by B.N.H. I/we have completed an up-to-date medical form and agree to inform B.N.H. staff of changes affecting its accuracy In the event that our son/daughter is injured, ill, or in need of medical attention and I am unable to be contacted I authorized B.N.H. staff to seek medical attention on my behalf.  I/we authorize my son/daughter to participate in all activities associated with the Leadership Program including trips outside the centre. I/we understand that my child will be supervised by a responsible B.N.H. staff person during these trips and that he/she will travel in either a licensed vehicle or public transit. I/we understand that I/my son/daughter will be dismissed immediately for: use of illicit drugs or alcohol while taking part in agency sponsored activities. Harassment, physical aggression, including threats directed toward other participants, staff, volunteers or campers/families profanity and verbal abuse directed toward others, or becomes unwilling to follow the reasonable direction given to them by B.N.H. staff. We authorize B.N.H. to use any photographs taken of our son/daughter in B.N.H. brochures and promotional materials. I/we understand that Provincial criminal record search is required for volunteer/work positions with the Neighborhood House childcare programs. I/we understand by signing this form, I/we become members of B.N.H. Society operated by B.N.H.

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