Participant Waiver

  • I understand that my participation in these classes is voluntary and at my own risk. I take responsibility for any activity I elect to participate in. I acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries including death, damages or loss regardless of severity which I may sustain as a result of participating in any and all activities connected with/associated with these classes. I agree to waive and relinquish all claims I may have as a result of participating in the program against Breast Cancer Action (BCA) and all officers, agents, servants, employees and/or against the instructor or substitute teacher. I understand that any photography taken while participating in a class or related event may be used for promotional purposes by BCA. In the event of emergency, I authorize BCA and the instructor to secure from any licensed hospital, physician and/or medical personnel any treatment deemed necessary for my immediate care. I have carefully read, fully understand and agree to the aforementioned. Further, to the best of my knowledge, the health information provided above is accurate. Personal information will be kept secure and confidential.
  • Date Format: MM slash DD slash YYYY
    I agree to be bound by the terms above
  • Emergency Contact Information