Permission for Child to Participate in Activity (Canada)

Permission to be obtained by a sponsor of an activity from the parents of a child participating.

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This type of parental permission can be used whenever it becomes necessary for a parent to give their permission so that their child can participate in an organized activity (i.e. a school trip, scouting trip, sports team etc.). This form includes a provision for emergency medical care and emergency contacts.

This form includes special formatting features to assist you in completing the agreement.

This form can be used in the following provinces: Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Saskatchewan and Yukon.
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.
Permission for Child to Participate in Activity 
 
TO:   [Name of Person Organizing Activity] (the "Organizer")
 
IN CONSIDERATION OF the Child named below (the "Child") being permitted to participate in the Activity, the undersigned, parent or legal guardian of the Child, on behalf of myself, my heirs, executors, administrators and assigns, hereby:
1.   Gives permission for the Child to participate in the Activity and assumes all risk of injury or harm to the Child associated with such participation.
2.   Releases and forever discharges the Organizer and its staff, employees, agents, representatives, successors and assigns (collectively the "Releasees") of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action (collectively the "Claims") in respect of death, injury, loss or damage to the Child, howsoever caused, arising or to arise by reason of or during the Child's participation in the Activity, whether prior to, during or subsequent thereto and notwithstanding that any Claim may have been contributed to or occasioned by the negligence of any of the Releasees.
3.   Consents to any of the staff, employees, agents and representatives of the Organizer administering or consenting to the administration of such emergency medical care to the Child as such person deems appropriate in the circumstances.
4.   Understands and acknowledges that the Organizer does not carry or maintain health, medical or disability insurance coverage for the Child and therefore agrees to assume responsibility for such insurance coverage on the Child.
I HEREBY ACKNOWLEDGE READING, UNDERSTANDING AND AGREEING WITH THE FOREGOING.
 
Name of Child
 
Signature of Parent
 
 
 
Date
 
Name of Parent
 
 
 
Alternate Contact in Case of Emergency
 
Address of Parent
 
 
 
Relation of Contact
 
Telephone No. of Parent
 
 
 
Address of Contact
 
Name of Child's Physician
 
 
 
Telephone No. of Contact
 
Telephone No. of Child's Physician
 
Number of Pages4
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#28536
This is the content of the form and is provided for your convenience. It is not necessarily what the actual form looks like and does not include the information, instructions and other materials that come with the form you would purchase. An actual sample can also be viewed by clicking on the "Sample Form" near the top left of this page.
Permission for Child to Participate in Activity 
 
TO:   [Name of Person Organizing Activity] (the "Organizer")
 
IN CONSIDERATION OF the Child named below (the "Child") being permitted to participate in the Activity, the undersigned, parent or legal guardian of the Child, on behalf of myself, my heirs, executors, administrators and assigns, hereby:
1.   Gives permission for the Child to participate in the Activity and assumes all risk of injury or harm to the Child associated with such participation.
2.   Releases and forever discharges the Organizer and its staff, employees, agents, representatives, successors and assigns (collectively the "Releasees") of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action (collectively the "Claims") in respect of death, injury, loss or damage to the Child, howsoever caused, arising or to arise by reason of or during the Child's participation in the Activity, whether prior to, during or subsequent thereto and notwithstanding that any Claim may have been contributed to or occasioned by the negligence of any of the Releasees.
3.   Consents to any of the staff, employees, agents and representatives of the Organizer administering or consenting to the administration of such emergency medical care to the Child as such person deems appropriate in the circumstances.
4.   Understands and acknowledges that the Organizer does not carry or maintain health, medical or disability insurance coverage for the Child and therefore agrees to assume responsibility for such insurance coverage on the Child.
I HEREBY ACKNOWLEDGE READING, UNDERSTANDING AND AGREEING WITH THE FOREGOING.
 
Name of Child
 
Signature of Parent
 
 
 
Date
 
Name of Parent
 
 
 
Alternate Contact in Case of Emergency
 
Address of Parent
 
 
 
Relation of Contact
 
Telephone No. of Parent
 
 
 
Address of Contact
 
Name of Child's Physician
 
 
 
Telephone No. of Contact
 
Telephone No. of Child's Physician
 

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