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 and Release

I declare that I intend to participate in the “Our Hospital Walk/Run” (the “Event”) organized by the North Bay Regional Health Centre Foundation (the “Foundation”) on Sunday, September 27, 2020. I understand that the North Bay Regional Health Centre (the “Hospital”) is the beneficiary of the funds raised from this event.

I understand and acknowledge that it is my decision to participate in the Event and that I am choosing to do so voluntarily and at my own risk.

I understand that neither the Foundation nor the Hospital take any responsibility for any harm, loss or damage to me or my personal property arising or resulting from my participation in the Event.

I understand and acknowledge that there may be risks associated with my participation in the Event which are further outlined in the brochure provided and/or on the Event website, 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 Event will be supervised and that it is my responsibility to inform myself of the risks involved by my participation and to monitor my progress in the Event and seek assistance and/or medical attention as necessary.

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

I hereby fully release, indemnify, hold harmless and forever discharge the Hospital and the Foundation and their respective directors, officers, employees, agents, staff and volunteers, as well as all sponsors and contributors from all actions, causes of action, suits, claims, liability, damages and demands of any kind if I suffer harm, injury, death or damage to my personal items/property as a result of my participation in the Event.

Consent for Photography/Use of name

I acknowledge and understand that by checking “Yes” and signing below, I give permission for and consent to the use of my name and picture without further notice on or in connection with any television or radio program, motion picture, print media or the advertising and publicizing of the Event as may be designated by the Hospital and/or the Foundation (the “Promotions”) and waive all rights to remuneration or otherwise in connection with the Promotions.

Parent or Guardian Name: