Name: Youth Physical Challenge: Volleyball
Start: 2023-06-27T16:30:00-04:00
End: 2023-06-27T17:30:00-04:00

PARTICIPANT INFORMATION
Name(Required)
Legal Name Last Name Preferred name
Date of Birth (dd/mm/yyyy)(Required)
DD slash MM slash YYYY
Age(Required)
Phone
Email(Required)
Parent / Guardian Information
Parent / Guardian Name(Required)
First Last
Relationship to participant(Required)
Phone Number(Required)
Email(Required)
Emergency Contact
Name(Required)
First Last
Phone Number(Required)
Required Information
Address(Required)
Street Address Address Line 2 City Province Postal Code
Status in Canada(Required)
Grade(Required)
Phone Number(Required)
OUTREACH FEEDBACK
How did you find out about this program?
- HMC Staff or Settlement Worker
- School
- Friend or Family
- Brochure/Flyer/Poster
- Email/Newsletter
- Other
CONSENT
LIABILITY WAIVER FORM AGREEMENT(Required)
- Consent
I give permission for my child mentioned above to partake in all activities of the “Volleyball for All” program as planned by HMC Connections. The Halton Multicultural Council and other community partners*, therefore, cannot be held liable for any accidents, injury, damage, or loss of personal possessions caused during the program activities both on and off-site. If applicable, I also give permission for my child to travel to and from volleyball sessions alone (e.g., via public transit, on foot). All the same, I understand that the Halton Multicultural Council and other community partners (*Town of Oakville), are not liable for the safety and well-being of your child under these circumstances. I understand all the risks and liabilities involved and, as such, agree to the terms and conditions above.
CONSENT FOR RELEASE OF INFORMATION(Required)
I, hereby authorize HMC Connections to exchange & disclose my information internally with HMC programs. I have asked HMC for assistance and give full permission to disclose my personal information (if required) to IRCC & other applicable Service Providers for support, guidance, advocacy, information, or referrals.
- Yes
- No
MEDIA/ELECTRONIC/PRINT/PUBLICATIONS/COMMUNICATIONS RELEASE FORM(Required)
I, the above named volunteer, student, employee, group, participant at the Halton Multicultural Council (HMC), unequivocally consent to the publication (including HMC social media accounts and website), release and transmission of the digital/electronic/print/photographs, to the extent that they may deemed necessary for express use thereof. This release and consent is voluntary. If you don’t wish to participate, there is no obligation on your part.
- Yes
- No
SIGNATURES
PARTICIPANTS 18 YEARS AND OLDER CAN SIGN THE REGISTRATION FORM THEMSELVES. PARTICIPANTS 17 AND UNDER MUST HAVE THEIR PARENT/GUARDIAN SIGN THE FORM.
Date(Required)
MM slash DD slash YYYY
Signatures(Required)
By typing my name below, I confirm that I have read and understood the information above.

Youth Physical Challenge: Volleyball

June 27 @ 4:30 pm - 5:30 pm

Youth Physical Challenge: Volleyball

PARTICIPANT INFORMATION

Parent / Guardian Information

Emergency Contact

Required Information

CONSENT

SIGNATURES

Details

Head Office

North Oakville

Burlington

Milton

Georgetown

Call us at 905-842-2486

STAY CONNECTED