REGISTRATION FORM FOR EVOLVE SKATE & SCOOTER CAMP

REGISTRATION FORM FOR EVOLVE SKATE & SCOOTER CAMP

Evolve Skate & Scooter Camp Participant Information
Full Name of Participant *
Select the Product type	Lessons at Ashbridges on Sundays, from September 20 to October 11 2016 - $180+HST Lessons at Markham on Sundays, from September 20 to October 11 2016 - $180+HST
What is your overall skill level? *
Are you a Skateboarder or Scooter Camper? *

Grade
Gender *	Male Female
Date of Birth *
How did you hear about us?
Family Doctor:		Health Card Number:

I would also like to sign up a sibling or second camper.

Full Name of Second Participant *
Select the Product type	Lessons at Ashbridges on Sundays, from September 20 to October 11 2016 - $180+HST Lessons at Markham on Sundays, from September 20 to October 11 2016 - $180+HST
What is your overall skill level?
Are you a Skateboarder or Scooter Camper?

Grade
Gender *	Male Female
Date of Birth *
Family Doctor:		Health Card Number:


PARENTS/LEGAL GUARDIAN INFORMATION
Name:
Current Address:
City:		Province/State:		Postal/ZIP Code:
Home Phone:		Cell Phone:		Work Phone:
Email:

EMERGENCY CONTACT INFORMATION (Check to use Parent/Guardian Information: )
Name: *
Relationship: *
Home Phone: *		Cell Phone:		Work Phone:
Email: *

Would you like to purchase the following additional items:
Insurance	This insurance is very important to consider. If you purchase the insurance and your son or daughter becomes physically ill before or during camp you can make a claim against the insurance for the unused portion of camp. Given the nature of the camp, we highly recommend this insurance option.			$65	Quantity
Enter Promotional code(if any):

You have two choices for payment:
	Pay securely with your credit card		Pay with Cheque. Please make cheque out to Evolve Skate Camps, 69 Wingold Ave Suite 120 Toronto, Ont M6B 1P8

Acknowledgement
I ATTEST AND VERIFY THAT I AM SIGNING AS THE PARENT OR LEGAL GUARDIAN ON BEHALF OF THE EVOLVE SKATE CAMP PARTICIPANT UNDER THE AGE OF 18 YEARS OR THAT I AM THE PARTICIPANT AND I AM ABOVE 18 YEARS OF AGE. By completing the registration form online for this Program for myself or as legal guardian of the Participant, in an electronic format I hereby apply for enrollment of myself or my son or daughter, on the Program provided by Evolve Skate Camp ("Evolve") subject to the following terms and conditions (the "Terms and Conditions" or "Agreement").
1)TRAVEL ARRANGEMENTS AND RULES: I authorize Evolve Skate Camp Inc. and its representatives to make any arrangements, rules and regulations they may deem advisable, in their discretion, for the well-being and welfare of Evolve Skate Camp Inc. Participants. 2)WAIVER: In CONSIDERATION for the skateboard camp program and lessons being offered by Evolve Skate Camp Inc. (hereafter "Evolve"), I hereby represent and warrant that I am the parent or legal guardian for the Evolve Skate Camp Inc. Participant and I recognize on his/her behalf (for the purposes hereof, the Participant and I shall be collectively referred to as the "Releasor") that the Evolve Skate Camp Inc. Program in which the Releasor has elected to participate (the "Program") is designed for skateboarding and therefore carries with it inherent risks including, but not limited to: the hazards of traveling by a variety of means, the dangers of skateboarding, falling off your skateboard, colliding with other skateboarders, getting hit by skateboards, playing ball games, swimming in public pools and participating in other adventure activities, the risk of accident or illness in remote locations without medical facilities, the dangers of wild animals, forces of nature, acts of God, extreme weather conditions, physical exertion, evacuation difficulties, and unforeseen delay. The Releasor represents and warrants that he/she is fully informed of these and other risks inherent to the Program. The Releasor further represents and warrants that he/she is voluntarily participating in the Program and hereby assumes all risk of death, injury, illness, or any damage, loss or theft of any personal property. The Releasor hereby releases and discharges Evolve and its officers, directors, shareholders, affiliates, employees, agents, representatives, successors and assigns from any and all claims or causes of action arising out of the Releasor's participation in the Program, except for those claims arising out of Evolve's gross negligence or willful misconduct. THE RELEASOR AGREES AND ACKNOWLEDGES THAT HE/SHE HAS CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTANDS THAT IT IS A RELEASE OF ALL LIABILITY. The Releasor hereby affirms that he/she has sought or declined to seek independent legal advice with respect to this Waiver and Release. IN ADDITION, THE RELEASOR HEREBY WAIVES ANY RIGHT THAT HE/SHE MAY HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM FOR DEATH, INJURY OR LOSS OF ANY KIND AGAINST EVOLVE or its affiliates, employees, agents, representatives, successors and assigns FOR NEGLIGENCE OR ARISING OUT OF OR RELATING TO THE RELEASOR'S PARTICIPATION IN THE PROGRAM EXCLUDING GROSS NEGLIGENCE OR WILFUL MISCONDUCT. THIS WAIVER AND RELEASE SHALL BE BINDING ON THE RELEASOR AND HIS/HER PERSONAL REPRESENTATIVES, HEIRS, EXECUTORS, ADMINISTRATORS AND ASSIGNS. 3)CANCELLATION (must be by written notice to Evolve Skate Camp Inc. ): To secure a spot payment must be made in full. Period before 1st departure- cancellation charge: more than 63 days before-third party hold/penalty premiums only; 63 to 35 days before-the greater of hold charges or 60% of total invoiced departure program cost; 34 to 13 days before-90% of total invoiced departure program cost; 12 days before-100% of total invoiced departure program cost. 4)CHANGES IN PROGRAM: I recognize that that the route, schedules, itineraries, and mode of transport may be subject to alteration without prior notice due to local circumstances or events, which may include sickness or mechanical breakdown, strikes, events emanating from political disputes, climate and other unpredictable or unforeseeable circumstances. The itinerary provided for each program is merely representative of the types of activities contemplated, and the Company is under no contractual obligation to strictly follow it. During the program, if our services in the brochure or website must be altered, in whole or in part, Evolve Skate Camp Inc. will use all reasonable efforts to arrange for the supply of comparable services. 5)DISMISSAL AND DEPARTURE: The Participant is expected to comply with all Evolve rules and regulations. Evolve reserves the right to dismiss any Participant from the program that staff believes, in their discretion, presents a safety concern or medical risk, is disruptive, or otherwise conducts him or herself in a manner detrimental to the program. If a Participant is dismissed or departs from the Evolve Skate Camp Inc. program for any reason, no refunds will be granted. I am responsible for all costs of early departure, whether for medical reasons, dismissal, personal emergencies or otherwise. These costs include, but may not be limited to: medical evacuation; medical treatment; travel fare; and meals, accommodations, compensation and expenses for staff who may accompany the Participant. 6)MEDICAL TREATMENT: I hereby agree that if the Participant is injured or becomes ill during the program, Evolve Skate Camp Inc. may, at my cost arrange or supply medical treatment, evacuation or any other emergency services as Evolve Skate Camp Inc. deems necessary or appropriate for the Participant's safety and well being. 7)LOST, STOLEN OR DAMAGED PROPERTY: Evolve Skate Camp Inc. and its representatives shall not be responsible for the Participant lost, stolen or damaged personal belongings. 8)PHOTO/VIDEO/WRITTEN STATEMENT RELEASE: I hereby authorize and give full consent to Evolve Skate Camp Inc. to copyright or use all photographs, videotapes and films in which the Participant appears or any written statements that the Participant makes while enrolled in any and all of their programs. I further agree that Evolve may transfer, use, or cause to be used these photographs, videotapes, films and statements for any and all exhibitions, public displays, publications, commercials, art and advertising purposes without limitation or reservation. 9)SEVERABILITY: In the event that any term or condition contained herein is unenforceable or void by operation of law or as being against public policy or for any other reason, then such term or condition shall be deemed to be severed from this Agreement or amended accordingly only to such extent necessary to allow all remaining Terms and Conditions to survive and continue as binding. 10)SUCCESSORS AND ASSIGNS: These Terms and Conditions shall inure to the benefit of and be binding upon the Company and the Participant and their respective heirs, legal personal representatives, successors and assigns. 11)APPLICABLE LAW AND VENUE: I understand that this application and all aspects of the participants relationship with Evolve Skate Camp Inc. will be governed by the laws of the Province of Ontario . Furthermore, any lawsuit or legal proceedings of any kind may only be filed in Toronto , Ontario , Canada . 12)COMPLETION AND PERMISSION TO PARTICIPATE: I have accurately completed the Registration Form and have read, understand and agree to the Terms & Conditions outlined above. I hereby give permission for my child to participate in all Evolve Skate Camp Inc. program activities whether conducted by Evolve Skate Camp Inc. staff or Evolve Skate Camp Inc. outside contractors. This Application shall be binding only when the electronic data is received, together with an initial monetary deposit, has been received by Evolve Skate Camp Inc. and then reviewed and executed by Evolve Skate Camp Inc.
I have read and agree to the Terms and Conditions
			Security Code:

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