Youth Services Consent Form

Contact Information



Emergency Contact

Authorized Pickups

Medical Information

Does the participant have a life-threatening allergy or condition?
Does the participant have an Epinephrine Auto-injector?
Does the participant require assistance in order to participate in this program?
Does the participant have behaviours that staff should be aware of?
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

  1. 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;
  2. 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;
  3. 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
  4. This agreement shall be effective and binding upon my executors, administrators, assigns and representatives, in the event of my death or incapacity.
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