Back to School Form « Love Our Lives

Love Our Lives

Back to School Registration

Friday August 24th 2020 - August 28th 2020

Online Learning

Participant's Name *

First

Last

Birth Date (MM/DD/YYYY) *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent's Name *

First

Last

Home Number

Cell Number

Email *

myname@example.com

Informed Consent and Acknowledgement *

I agree

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.

Media Release *

I give permission
I do not give permission

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.

Additional Information

Signature *

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.

Payment

Price: $ 50.00

E-transfers can be sent to leanne-p7@hotmail.com.

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