Empowering Pathways Services - Camps & Respite Services WavierParticipant NameDate of BirthParent,Guardian Name (if under 18)PhoneEmail AddressConsent & AcknowledgementBy registering for Empowering Pathways Services Camps and Respite Programs, I acknowledge that:● Participation may involve indoor/outdoor activities, and some risks are involved.● All medical, behavioural, or dietary needs have been shared with staff.● In case of an emergency, staff may seek medical treatment for the participant.Release of LiabilityI release Empowering Pathways Services, its staff volunteers and affiliates from any liability for injury, illness, or loss, except in cases of gross negligence or intentional misconduct.Behavior & SafetyI understand that safety and respect are required. If a participant’s behavior endangers themselves or others, staff may modify or end participation.Media ConsentI allow photos/videos of the participant to be used for program promotion.I do not allow photos/videos to be used.AgreementBy checking the box below, I confirm that I have read and agree to this waiver. *I agree with the terms above.Submit
