High Risk Activity Release Form

(minor’s name) (the “Minor”).(Required)

First Middle Last

DEFINITION: In this Agreement, the term “Activities” shall include all activities, services and use of equipment provided by Big Brothers Big Sisters of Central Vancouver Island (“BBBSCVI”), in the Connect, type activity below:(Required)

Terms and Conditions(Required)

I have carefully read and agree to all the terms and conditions of this agreement.

IN CONSIDERATION of BBBSCVI allowing the Minor to take part in the Activities, I
the parent/guardian of the Minor agree that:
1. I KNOW the Minor’s experience and capabilities, and believe the Minor has no
medical or other condition that will impair his/her ability to understand
instructions and participate in the Activities without creating a risk to
him/herself and other participants.
2. I UNDERSTAND that:
a. the Activities are inherently dangerous in which the Minor participates at
his/her own risk;
b. the Activities may involve risks (the “Risks”) and dangers of personal
injury, accidents or illnesses (including death) and hazards, as well as
other risks and losses including risks and losses not known to me or not
anticipated at this time. The risks, dangers and hazards include, but are
not limited to, injuries from:
i. The hazards particular to the Activities in which the Minor is
participating;
ii. Executing strenuous and demanding physical techniques;
iii. Water hazards, terrain obstacles, waves, unstable surfaces and
extreme weather conditions;

iv. Vigorous physical exertion, strenuous cardiovascular workouts and
rapid movements;
v. Exerting and stretching various muscle groups;
vi. Failure to properly use any piece of equipment or from the
mechanical failure of any piece of equipment;
vii. Contact, colliding, falling or being struck by other participants or
equipment;
viii. Blunt force trauma, serious soft tissue injuries, broken bones, or
spinal cord injuries which may render the Minor permanently
paralyzed;
ix. Surface abrasions, entanglements, entrapments, or flying objects
and debris;
x. Drowning including but not limited to, equipment failure or
entanglement, falling out of boat/watercraft into the water,
capsizing or being knocked unconscious in the water; and
xi. Cold water conditions resulting in hypothermia and the potential
risks and hazards above.
c. the Risks may be caused by the Minor’s own actions, or inactions, the
actions or inactions of others, the conditions in which the Activities take
place, or the negligence of the “Releasees” named below;
and I fully accept and assume all such Risks and all responsibility for losses,
costs and damages I or the Minor incur as a result of the Minor’s participation
in the Activities.
3. I REPRESENT that I am of the age of majority (19 years of age) and legally
competent to sign this Agreement.
4. I ACKNOWLEDGE that the Minor has been advised and is expected to wear
an approved Personal Flotation Device when on the water while participating
in the Activities.
5. I HEREBY RELEASE and agree not to commence any legal action against
BBBSCVI, its administrators, directors, agents, officers, volunteers,
contractors, representatives, employees, heirs and executors (all of who are
hereinafter collectively referred to as the “Releasees”) from all liability, claims,
demands, actions or causes of action, losses or damages caused or alleged to
be caused entirely or in part by the negligence, breach of contract or breach
of any statutory or other duty of care (including any duty of care owed under
the Occupiers Liability Act, RSBC 1996, c 337) of the Releasees.
6. INDEMNIFICATION AND HOLD HARMLESS: I also agree to indemnify and
hold harmless the Releasees from any and all claims, actions, suits,
procedures, costs, expenses, damages and liabilities, including attorney’s fees, for any property damage, loss or personal injury to myself or any third party,
brought as a result of the Minor’s involvement in the Activities and to
reimburse them for any such expenses incurred.
I HAVE READ THIS AGREEMENT, fully understand its terms, understand that I have
given up substantial rights by signing it and have signed it freely and voluntarily and
intend for the Agreement to be a complete and unconditional release of all liability
and to the greatest extent allowed by law. I agree that if any part of the Agreement
is held invalid, the remaining parts shall continue in full legal force and effect. I
further agree that this Agreement is effective and binding upon my heirs, next of kin,
executors, administrators, assigns and representatives in the event of my death or
incapacity.

Signature of Parent or Legal Guardian (type name):(Required)

Relationship to Minor:(Required)

Date(Required)

I, _____________________________, identified herein as the Minor, accept and assume the Risks associated with the Activities including but not limited to personal injury, accidents or illnesses (including death) as well as other risks and losses including risks and losses not known to me or not anticipated at this time. (Type Name below):(Required)

Signature of Minor (type name):(Required)

Date(Required)

Signature of Witness (type name):(Required)

Date(Required)