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 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 Breast Cancer Action. In the event of emergency, I authorize Breast Cancer Action 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.

Name*

First Last

Email*

Phone*

Address when taking classes*

Street Address Address Line 2 City Province Postal Code

Hidden

Date of event

Approval*

I agree

I agree to be bound by the terms above

Emergency Contact Information

Name*

First Last

Phone*

Relation*

Confirmations

I understand that:

These sessions will be delivered via secure video or telephone, not in person
No recordings or screenshots of the session will be made by either party
I will need an ethernet connection or a strong Wi-Fi connection
I must use either Firefox or Google Chrome browsers