Volunteer

Registration

Your Name (required):

Address (required):

City (required):

Postal Code (required):

Phone Number (required):

Your Email (required):

Team Name (if applicable):

Yes, I wish to volunteer during the walk run on October 15, 2017.

Please place me in the following area:

Volunteer training and a full job description will be supplied prior to the event. After completing this form, you will be contacted with specific details. Return in person to NBRHC, 50 College Dr. Pod A2 or mail to NBRHC Foundation, Box 2500, North Bay P1B 5A4, by fax 495-8121 or email to meaghan.byrnes@nbrhc.on.ca.

Our Hospital Walk/Run Waiver

I declare that I intend to participate in “Our Hospital Walk/Run” organized by North Bay Regional Health Centre Foundation. I understand that the North Bay Regional Health Centre is the beneficiary of the funds raised from this event.

I acknowledge that my participation in the Walk/Run is purely voluntary. I understand that neither the North Bay Regional Health Centre Foundation nor North Bay Regional Health Centre take any responsibility for any harm, loss or damage to myself or my personal property arising or resulting from my participation in the Walk/Run.

I understand and acknowledge that there may be risks associated with my participation in the Walk/Run which are further outlined in the brochure provided, and which may include serious physical injury, permanent disability, and/or death. I further understand that these risks may be relative to my own level of skill, fitness, and/or health.

I understand that not all parts of the Walk/Run will be supervised and that it is my responsibility to inform myself of the risks involved in my participation and to monitor my progress in the Walk/Run and seek assistance and/or medical attention as necessary.

I assume full responsibility for consulting with a physician prior to and regarding my participation in the Walk/Run. I understand that medical care and/or treatment are not being provided as part of the Walk/Run. In case of an emergency, I understand that 911 will be called.

I hereby release the North Bay Regional Health Centre and the North Bay Regional Health Centre Foundation; and their respective directors, officers, employees and agents; all sponsors; contributors and volunteers from all actions, causes of action, suits, claims, liability, damages and demands of any kind, whether direct, indirect, special, exemplary or consequential, including interest thereon (the “Claims”) as a result of my participation in the Walk/Run.

I hereby agree to indemnify, hold harmless and forever discharge the North Bay Regional Health Centre and the North Bay Regional Health Centre Foundation; and their respective directors, officers, employees, volunteers and agents from and against all Claims whatsoever incurred by the Hospital or such other persons if I suffer harm or loss, injure someone else or damage property as a result of my participation in the Walk/Run.

Consent for Photography/Use of name

I acknowledge and understand that by checking and signing below, I give permission for and consent to the use of my name and picture on or in connection with any television or radio program, motion picture, print media or the advertising and publicizing of the Walk as may be designated by the North Bay Regional Health Centre Foundation(the “Promotions”) and waive all rights to remuneration or otherwise in connection with the Promotions.

I have read the above waiver and consent and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

Permission is required from a Parent or guardian for children under 18 years of age who wish to volunteer.
Parent or Guardian Name:

I have read the above waiver and fully understand its contents. I voluntarily agree to the terms and conditions stated above.