Grande Prairie and Area Safe Communities - Liability Waiver Form

Release of Liability Waiver

I, the undersigned, as the parent or legal guardian of the children listed, do hereby give my full consent and approval for the children listed as above, “the Participant(s)” to participate in activities at Safety City located at 10318 92 Street, Grande Prairie, Alberta, operated by Grande Prairie and Area Safe Communities Committee, and agree as follows:

I warrant and represent that I am the parent, legal guardian of the Participant(s) or have been duly authorized by the parent or legal guardian to represent the Participant(s) named above.

By entering Safety City I acknowledge the inherent risks present in an outdoor play environment. While Grande Prairie and Area Safe Comunities Committee (GPASC) and its staff work diligently to provide a safe environment for all, certain risks, whether inherent in the facility itself or caused by myself, any of the Participant(s), or other participants of Safety City, are unavoidable. These risks include, but are not limited to, damage to personal property, personal injury or death. I voluntarily assume and accept all risks to myself, the Participant(s), and my personal property.

I hereby, for myself and on behalf of the Participant(s), agree to save and hold harmless and fully indemnify Grande Prairie and Area Safe Communities Committee Management and Staff, on the account that all normal safety procedures have been taken on behalf of Management and Staff, from any and all liability for any personal injury or injury to any third-party child resulting from the Participant(s) actions/participation in the above-mentioned activities.

I hereby release Grande Prairie and Area Safe Communities Committee and its entire staff from any and all liability, on the account that all normal safety procedures have been taken on behalf of Management and Staff, for any injuries that the Participant(s) may sustain as a result of any activities taken place at Safety City.

Parent/Adult Information

Relationship

First name *

Last name *

Email *

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Participant / Child Info

This section is for participating minors (ages 17 or under). If you are 18 or over, you only need to complete Step 1 above. To add additional children, click the +Add button. You must be the legal parent or guardian of the participant.

First name *

Last name *

Gender Please specify

Date of birth *

Please indicate the date the child is attending and the reason. Examples are school trip, birthday party, or open bike time. *

Please indicate the date the child is attending and the reason. Examples are school trip, birthday party, or open bike time.

I warrant and represent that I am the parent, legal guardian of or have been duly authorized by the parent or legal guardian to represent the Participant(s) named above. *

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I, the undersigned, as the parent or legal guardian of, do hereby give my full consent and approval for the children listed as above, "the Participant(s)" to participate in activities at Safety City and agree as above:

I have read and accept *

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