Contact Information
Parent/Guardian
Emergency Contact
Authorized Pickups
Medical Information
Please Note: This information helps staff determine if we can accommodate the participant in our program. If you have indicated "yes" to any of the above questions, you must speak with staff before your child can participate in the program.
Out Trip Permission
By checking the above box, I hereby consent that New Westminster Parks and Recreation staff is permitted to take my child on outings that may use one or several modes of transportation (i.e. walking, public transit, City or commercial vehicle such as buses or passenger vans).
Youth Services
Youth Services Outtrip Participants are permitted to:
Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement
- To freely and fully assume all risks associated with my child's use of the premises and the facilities and my child's participation in this program;
- To waive and and all claims that I have or may in the future have against the City and to release the City from any and all liability for any loss, damage, expense or injury including death that my child may suffer as a result of his/her participation in this program due to any cause whatsoever;
- To hold harmless and indemnify the City from any and all liability for any damage, loss, expense or injury to any third party resulting from my child's participation in this program; and
- This agreement shall be effective and binding upon my executors, administrators, assigns and representatives, in the event of my death or incapacity.
The City of New Westminster is committed to protecting your privacy. This information is collected by the City of New Westminster under Section 26(c) of the Freedom of Information and Protection of Privacy Act and will be used for the purpose of administering youth services programs
. Should you have any questions about the collection of this personal information please contact the FOI and Privacy Coordinator, 511 Royal Avenue, New Westminster, V3L 1H9, . 
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