Love Our Lives
The A.R.T. Room Registration

Tuesday October 9th 2018 @ 4:30PM

myname@example.com

myname@example.com

I hereby give my approval for my child’s participation in any and all activities prepared by Love Our Lives during the Back to School Workshop. In exchange for the acceptance of said child’s candidacy by Love Our Lives, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Love Our Lives 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 Love Our Lives and Louise Russo W.A.V.E. including all counselors and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the camp.

As Parent and/or Guardian of the named participant, 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 athlete. 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 Love Our Lives and its affiliates, including Directors and Counsellors, to provide the needed emergency treatment prior to the child’s admission to the medical facility.

I grant permission to Love Our Lives to use my child’s/children’s photographs and/or videos for use in Love Our Lives publications including videos, recruiting brochures, newsletters, magazines, website images social media or other electronic fomrs of media. All images belong to Love Our Lives for promotion purposes.

I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown. I waive any right to royalties or other compensation arising from or related to the use of the image.

I have read and I understand the contents, meaning and impact of this realse. I understand that I am free to address any questions regarding this release by addressing those questions prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

I give CTV/Rogers TV permission to film and interview my child in relation to the Love Our Lives Organization and this program. I give CTV and Rogers TV permission to use documented footage for the documentary as well as future programs which highlight Love Our Lives.

BY ACKNOWLEDGING AND SIGNING YOUR NAME ABOVE, YOU 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.

Price: $ 10.00

This payment goes towards your child’s materials.

Sorry we are having paypal technical difficulties. If you wish to pay through paypal you can pay to: payments@loveourlives.org. If you wish to pay via email transfer you can email the funds to leanne-p7@hotmail.com. We apologize for any inconveniences this may have caused.