Required fields are marked with asterisks (*)

Free Outdoor Fitness Events

Free Outdoor Fitness Events:

Sunset Yoga at Veterans’ Point Gardens

Zumba® in the Square at Pat Bayly Square

Registration Form

This form must be filled out in full by each person who wishes to participate.

Waiver Form for Participant

RECOMMENDATION

You and/or your parent or guardian are urged to consult with the participant’s family medical practitioner prior to participating in any activity(ies)/ program(s)/ event(s) offered by the Town of Ajax (The Town).

COVID-19

While in the facility, consider wearing a mask, physical distancing and sanitizing guidelines when possible. Please ensure you self-screen for any Covid-19 signs and symptoms and refrain from participating in the activity if you have any symptoms of Covid-19.

ELEMENT OF RISK

This activity/ program may present various elements of risk. Accidents resulting from such activities may occur and cause injury. These accidents result from the nature of the activity and can occur without any fault on either the part of the Town of Ajax or its employees, agents or representatives. By choosing to participate in the activity, the participant and/or their parent or guardian is assuming the risk of an accident occurring. Participants and or their guardian MUST assume the risk associated with the activity. The participant agrees to use caution and wear appropriate clothing and protective equipment, including but not limited to items as supplied or recommended by the Town of Ajax. The participant understands that part of the risk involved in undertaking any activity or program is relative to their own state of fitness or health (physical, mental or emotional) and the awareness, care and skill with which they conduct themselves in any activity or program. The participant acknowledges that it is the participant’s right and responsibility to decrease or completely stop participating during any activity should the participant feel any pain, discomfort, fatigue or feel unsafe to continue doing so and that the participant will immediately (as soon as practical) inform the program employees or volunteers of their concerns or symptoms. It is the responsibility of the parent or guardian of the participant to inform and ensure that their participant understands this right

RELEASE AND INDEMNIFICATION AGREEMENT

In consideration of my (the participant) being permitted to participate in any activity(ies)/ program(s)/ event(s) offered by the Town of Ajax; I, myself, and/or my parent or guardian, my heirs, executors, administrators, successors and assigns do hereby release and forever discharge, waive and save harmless, defend, protect and keep indemnified the Town of Ajax and all of their respective agents, employees and representatives from and against any and all kinds of actions, claims, costs, expenses and demands in respect of death, injury, loss or damage, to my person or property however caused arising out of my being permitted to attend at or in any way take part prior to, during or subsequent to the activity(ies)/ program(s)/ event(s) as a participant or spectator.

CONSENT TO MEDICAL TREATMENT

The participant and/or their parent or guardian hereby gives their permission for the Town employees or volunteers to provide or arrange for such first aid or other medical treatment or care, including but not limited to transportation to hospital, as such employee or volunteer may consider necessary or advisable. I and/or my parent or guardian understand that all costs related to such actions shall be the participant’s and/or the guardian’s responsibility and I agree to pay for and/or reimburse the Town of Ajax for whatever costs that are incurred.

PHOTO WAIVER

In the course of all program activities, photos may be taken and audio and/or visual records may be made. The Town of Ajax reserves the right to use all photographs & videos of our activity(ies)/program(s)/event(s) for promotional purposes.

ACKNOWLEDGEMENT

The person signing this form acknowledges that they are at least eighteen (18) years of age and are legally authorized and capable and have read the above and understand that in participating in any program offered and/or attending any facility, the participant and/or their parent or guardian is assuming the risks associated with doing so.

Collection of Personal Information

Personal information collected on this form is collected under the Municipal Act, S.O.2001, c.25, and will  be used for the purpose of program registration, payment, aggregate statistical reporting and allocation of staff resources. Questions of this collection should be address to the Town of Ajax Records and Freedom of Information Coordinator at 65 Harwood Avenue South, Ajax, Ontario, L1S 2H9.

Accessibility

If you require this form in an alternative format, please contact the Town of Ajax Accessibility Coordinator, at 905-683-4550, or by e-mail at contactus@ajax.ca.