So You Think You Can Pow-wow 2016 Registration Form
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1 So You Think You Can Pow-wow 2016 Registration Form Participant Information First Name Last Name Age Address City/town Postal Code Gender Address Contact Telephone Number/s (306) (306) I AM REGISTERING FOR: (CIRCLE ONE) DANCING DRUMMING Please check one the applies to You (optional): Participant Questionnaire Aboriginal Métis Inuit Immigrant/Refugee Non- Aboriginal 1. Have you ever danced Powwow / been part of a drum group in the past? Circle: Yes or No (If yes please answer the following. If no move to question 2) How long have you danced/been part of a drum group? What style of Powwow dance (Dance participants only): Do you have Regalia? (Dance participants only): 2. Which Statement best describes your reasoning for joining the program, check all that apply: I want to do performances in the community To learn about the history Source of recreation To meet friends I want to dance/drum in competition at various pow wows I want to practice a healthy lifestyle I want to meet Elders I want to meet mentors 1
2 Liability Waiver hereby acknowledge that I/we have fully read, understood and unconditionally agree to all the provisions outlined in this Waiver, Release, Indemnity and Acceptance of Risks. By signing this Waiver, Release, Indemnity and Acceptance of Risks below, the participant and, if the participant is under the age of 18, the parent/legal guardian of the participant, confirm and agree that participation is voluntary and that the participant and, if the participant is under the age of 18, the parent/legal guardian of the participant, knowingly assume all risks associated with this participation. The participant and, if the participant is under the age of 18, the parent/legal guardian of the participant (on his/her/their own behalf and on behalf of his/her/their heirs, executors, personal representatives, and assigns) waive all claims against The Newo Yotina Friendship Centre, and its affiliated companies, its partners, any companies acting on its behalf, Newo Yotina Friendship Centre and each of their directors, officers, employees, volunteers, sponsors, independent contractors, agents and authorized representatives (the Releases ) from liability for any and all claims, demands, damages, costs (including legal costs), expenses, actions and causes of action, whether in law or equity, that any of us have or may in the future have against the Releases, including claims arising from their negligence. This waiver applies to any claims against the Releases of any kind relating to the participant s person or property including claims arising from (1) personal injury (including death) from accidents, injuries or illnesses arising from participation in various activities during and in connection with The Newo Yotina Friendship Centre; and (2) damage to, or loss or theft of property, and regardless of whether such death, injury, damage, loss or theft was caused or contributed to by the negligence of any of the Releases. further agree to waive all claims for injuries or financial claims against the Releases related to actions taken by a third party which may result in damages against the participant. agree to indemnify and hold harmless the Releases from and against any damages, interest or costs, including the full amount of all lawyers fees and disbursements, paid or payable by the Releases in connection with any claim the participant or others may bring in contravention of this Waiver, Release, Indemnity and Acceptance of Risks. The participant and, if the participant is under the age of 18, the parent/legal guardian of the participant further agree to indemnify and hold harmless the Releases with respect to any and all liability, costs and expenses incurred by any of the Releases as a result of the participant s participation in the Newo Yotina Friendship Centre So You Think You Can Pow Wow Program, which includes indemnifying and holding harmless the Releases from and against all claims and costs related to legal or other action brought against the Releases for damages caused by the participant. hereby acknowledge that in no event shall the maximum liability of the Newo Yotina Friendship Centre, its affiliates, employees, agents, volunteers and authorized representatives arising out of the participant s participation in the Newo Yotina Friendship Centre So You Think You Can Pow Wow Program, whether based upon contract, tort, negligence, strict liability or otherwise, exceed in the aggregate the amounts paid by the participant to the Newo Yotina Friendship Centre to participate in such Newo Yotina Friendship Centre So You Think You Can Pow Wow Program, and in no event shall the Newo Yotina Friendship Centre, its affiliates, employees, agents, volunteers and authorized representatives be liable for any damages other than direct damages, even if Newo Yotina Friendship Centre has been advised of the possibility of such damages. I have read the section entitled Liability Waiver above and agree to the terms contained therein (initials of participant and/or parent/legal guardian if participant is under 18). 2
3 By signing below and submitting this Waiver, Release, Indemnity and Acceptance of Risks, the participant and, if the participant is under the age of 18, the parent/legal guardian of the participant, acknowledge that we have read, understood and agreed to all of the provisions provided above. We understand that we are giving up rights, including the right to compensation for injury resulting from negligence of the Releases. We acknowledge freely and voluntarily signing the agreement and intend our signatures to signify a complete assumption of the inherent risks of participating in or observing activities in connection with the Newo Yotina Friendship Centre program/s and activities and a complete and unconditional release of liability, to the greatest extent allowed by law. Print name of Participant Witness Signature of Participant If Participant is under the age of 18, signature of his/her parent/legal guardian: Print name of parent or legal guardian Witness Signature of parent or legal guardian 3
4 Consent letter for participants of So You Think You Can Pow-wow I/We, Full Name(s) Am/are the lawful Parent(s)/Guardian(s) of child/youth Full Name The aforementioned child has my / our consent to be a participant in the Newo Yotina Friendship Centre s So You Think You Can Pow Wow program from January April Information about person(s) giving consent: First Name: First Name: Last Name: Last Name: Address: Address: Phone #: (306) Phone #: (306) (Authorized Signature) (Authorized Signature) 4
5 Release & Consent Form Newo Yotina Friendship Centre I hereby give permission to the Newo Yotina Friendship Centre to use: o Photographs o Audio Recordings o Visual Recordings Person/s Featured: Credit should be given to: I hereby authorize the Newo Yotina Friendship Centre to edit, alter, copy, exhibit, distribute, publish in print, video, audio recorded productions, and on the World Wide Web this material for purposes of publicizing the Newo Yotina Friendship Centres programs or other lawful purpose without payment or any other consideration. By signing this document, I understand that: The materials will be used only for nonprofit/educational purposes. The materials will become the property of the Newo Yotina Friendship Centre, stored in a place chosen by the Newo Yotina Friendship Centre and will not be returned to me. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. I waive any right to royalties or other compensation arising or related to the use of the materials. I hereby hold harmless and release and forever discharge the Newo Yotina Friendship Centre from all claims, demands, liability, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. I have read this release before signing below and I fully understand the contents, meaning, and impact of this release. Signature Printed Name Address City, Province & Postal code Phone Number Signature of Collector on behalf of the above named organization 5
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