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BCFC Summer Youth Program Registration Form 2025

Your Personal Details

DD slash MM slash YYYY
Are you currently attending school?
Do you have any health concerns that BCFC staff should be aware such as: Disabilities, allergies, asthma and etc?

Current Residential Address

Emergency Contact Information

Photo Consent:

I hereby grant permission to the BCFC Summer Program 2025 and Resilia Community Wellness Centre to use photographs, videos, or audio recordings of myself and/or my child for reasonable and appropriate purposes. These may include, but are not limited to funding reports, promotional materials, websites, social media platforms, and public presentations. I further authorize the use of my (or my child’s) image, likeness, and voice in any promotional or documentary content whether for print, digital, video, radio, or television related to the program, without expectation of compensation.

Parental Consent & Waiver of Liability:

This form must be completed for each participant and, if the participant is under 18-years old, must be signed by the participant’s parent or legal guardian. No participant will be allowed to participate in BCFC Summer Youth Program or BCFC Recreational Activities and games without this written consent. I, the undersigned, in consideration for my voluntary participation in the program, do hereby willfully acknowledge that my signature below attests to my understanding and agreement that: My participation status will be kept in good standing. I will not compromise myself in such a way as to do harm to the BCFC Summer Youth Program or BCFC Organization, knowing that participation may be revoked, with possible loss of payment or dues, for violent conduct or unreasonable behavior. I agree to pay for any and all damages to any property or indemnities caused by me willfully, negligently, or otherwise. I assume all risks and hazards associated with my participation in the BCFC Summer Youth Program and BCFC recreational activities and games. I am in proper physical condition to participate in recreational activities, sports, and games and have no illness, disease or existing injury or physical defect that would be aggravated by my participation. I will inform the Bilal Community and Family Centre if this status changes. I further acknowledge that this risk may involve loss or damage to me or my property, including the risk of death, or other unforeseen consequences, including those which may be due to the unavailability of immediate emergency medical care. I will wear the appropriate clothing, and protective equipment (e.g., mouthpieces) to all events and activities. The Bilal Community & Family Centre does not have personal injury insurance that covers my participation. Therefore, I should have a current, active, personal injury insurance policy in force, which covers my participation. Under any condition, I am responsible for any and all medical expenses arising from my participation in any BCFC Program, Activity, or event and while travelling to and from these events. I hereby release, waive liability, discharge, hold harmless, indemnify, and covenant not to sue, the Bilal Community & Family Centre, their associated directors, administrators, officers, managers, employees, coaches, trainers, volunteers, sponsors and advertisers, and other agents, from any and all liability incurred in the conduct of, and my participation in, their programs. This includes owners, lessors, and lessees of premises, municipalities, government agencies, successors, heirs, and assigns. I have completely read this document and fully understand its contents. I acknowledge that I have given up substantial rights by accepting this document and that I do so voluntarily. My signature attests to this on behalf of myself and my executors, personal representatives, administrators, heirs, next-of-kin, successors, and assigns.

Clear Signature
DD slash MM slash YYYY

If under 18:

Clear Signature
DD slash MM slash YYYY
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33 Warnock St, Winnipeg, Manitoba, R3E3L6, Canada

(204) 772-7358 |

info@bilalcommunitycentre.ca

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