CNA - Trust Event Registration Form

Participant Registration Information

* Select Event:

* Participant Full Name:

* Gender: MaleFemale

* Birth Date:

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* BC Care Card Number:

* Street Address:

Unit Number (if applicable):

* City:

* Country:

* State / Province / Region:

* Postal / Zip Code:

* Primary Email Address:

* Phone Number:

Alternate Phone Number:

* Emergency Contact (Name):

* Emergency Contact Phone Number:

* Aboriginal Ancestry: CNA MemberNon-CNA Member

If you selected that you are a CNA Member, please indicate which CNA Band you are with:

If you selected that you are not a CNA Member, please indicate where you are from:

* Status Card Number:

Assumption of Risk and Informed Consent for Participants:

This section must be completed by all program participants over the age of 18, or by the parents/legal guardians of participants aged 18 or under. Please read and complete the information presented below.

* Check one of the following: As a participant over the age of 18, I understand and acknowledge the following:
As a parent/legal guardian of a participant aged 18 or under, I understand and acknowledge the following:

Assumption of Risk

In consideration of my participation, or my child’s participation in this program and all of its related activities, I acknowledge and I am aware of, appreciate, and accept the inherent physical risks and the other possible RISKS, DANGERS, AND HAZARDS associated with participating in this program. This includes the possible risk of severe or fatal injury to me, my child or others. I understand that the inherent risks of sport and physical activity cannot be eliminated without jeopardizing the essential qualities of sport and physical activity. I have reviewed all of these risks, I understand them, and I still desire to participate in the program.

Acknowledgement of Responsibilities and Condition of Registration

I/my child will follow all the instructions and rules given by those responsible for, or, in charge of this program and all of its related activities while I am/my child is participating in this program. I understand and accept that the instructions and rules are in place to provide a safe environment for the entire program and all participants.
I/my child will obey all the rules and regulations pertaining to this program and all of its related activities.
To the best of my knowledge I am/my child is physically and mentally able to participate in all activities of this program.
If an injury occurs, I give permission to event/venue/ staff and/or adult leader in charge to provide emergency first aid treatment and transport or arrange emergency transportation for me/my child to a medical facility for emergency treatment.

Communication, Media Release and Privacy of Information

I hereby grant CNA, or affiliated bodies the right to use, without payment of any fee or charge, any written information (excluding information contained on a Medical Form), photograph, video, or other visual media of myself/my child, or program participant taken during the program activities for the purpose of furthering CNA objectives

This Section Applies to Participants over the age of 18 Only

I agree to HOLD HARMLESS AND INDEMNIFY the CNA, the event host partners, organizers and/or its agents from any and all actions, claims, demands, losses, judgments or costs of any nature to any third party resulting from my association with the CNA sanctioned event and I agree not to make any claims or take any proceedings against any person, society, corporation or other legal entity who might claim contribution or indemnity from CNA, the organizers and/or its agents in respect of matters which are subject of this Release. I agree that this Release shall bind my heirs, executors, administrators and assigns.

* I Agree (Participants Initials):

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT, that I understand, appreciate and accept the risks associated with my participation or my child’s participation in this program and all of its related activities.

* Full Legal Name:

* Today's Date: