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MOVE Forms & WaiversThis webform will take you through the following forms and waivers for electronic signature. These are required and must be completed in order to participate: 1. Waiver of Liability and Release (Required)* 2. Video/Photo Waiver and Media Consent (Optional) 3. Physical Activity Readiness Questions (Required)* The Liability and Release waiver and Physical Activity Readiness Questions must be electronically signed by a parent/caregiver for anyone under the age of 18. The Video/Photo Waiver and Media Consent is optional. If you decline to agree to the Video/Photo Waiver now, you can always agree to it at a later time. You will receive a copy of the completed waivers immediately by email. If you do not receive it, please check your junk mail folder.Participant's Full Name*This helps us connect your agreement to the correct Participant. Your Relationship to Participant* MOVE Participation Waivers1. Waiver of Liability and Release (Required)**Liability waiver: I acknowledge that there is a risk associated with participating in fitness activities and in exercising (collectively referred to herein as “the activities”). My participation in the activities offered online by the GoodLife Kids Foundation (“GLKF”) and its representatives, is completely voluntary, and I acknowledge that I am assuming all risks of injury to me or others including any illness or medical condition. I agree to a) release, indemnify and discharge GLKF, and its owners, officers, directors, agents, employees or independent contractors (the “Releasees”), from any and all claims or causes of action (known or unknown) which I may have arising out of my participation in the activities, including those arising out of the negligence of GLKF’s staff, agents or representatives; and b) to indemnify and save the Releasees harmless from any and all claims or causes of action (known or unknown) brought against the Releasees by any party arising out of my actions. I acknowledge that all Zoom meetings scheduled by a MOVE Coach from their GLKF account are automatically recorded and saved for quality and training purposes. I understand that recordings will be stored securely by GLKF for a minimum period of 1 year. I understand that any such recording is for internal use only unless I also agree to a separate photo/video waiver. By electronically signing below, I am agreeing to the terms and conditions of this Waiver on my own behalf. I acknowledge and agree that my heirs, executors, administrators and assigns will also be bound by this Waiver. I have read the Waiver of Liability and Release Agreement above, and by clicking this box I do hereby consent to the terms and conditions listed herein. (Required)2. Video/Photo Waiver and Media Consent (Optional)Video/Photo Waiver and Media Consent: I hereby authorize any images or video footage taken of myself, in whole or in part, individually or in conjunction with other images and video footage, which may be posted on social media outlets, specifically Youtube, Facebook, and Instagram, as well as on the GoodLife Kids Foundation website, and to be used for media purposes including promotional presentations and marketing campaigns. I waive any rights to privacy and compensation, which I may have in connection with such use of my name and likeness, including rights to be written copy that may be created in connection with video production, editing and promotion therewith. I also authorize the display and use of any media material created by me for the purposes of promoting the GoodLife Kids Foundation. I have read the Video/Photo Waiver and Media Consent, and by clicking this box I do hereby consent to the terms and conditions listed herein. (Optional)Your Full Name*Please enter your full name to confirm your electronic signature. Today's Date* MM slash DD slash YYYY Your Email Address*We will email you a copy when completed Participant DeclarationIf in doubt after completing the questionnaire, consult your doctor prior to physical activity.Has the Participant had (within the past 12 months) a bone, joint, or soft tissue (muscle, ligament, or tendon) problem or other medical conditions that could be made worse by becoming more physically active?* Yes No Has the Participant's doctor ever said that they should only do medically supervised physical activity?* Yes No PARTICIPANT DECLARATION*If you are less than the legal age required for consent or require the assent of a care provider, your parent, guardian or care provider must also sign this form. I, the undersigned, have read, understood to my full satisfaction and completed this questionnaire. I acknowledge that this physical activity clearance is valid for a maximum of 12 months from the date it is completed and becomes invalid if my condition changes. I also acknowledge that the community/fitness center may retain a copy of this form for its records. In these instances, it will maintain the confidentiality of the same, complying with applicable law. By clicking this box, I declare that I have read the Participant Declaration above. (Required)Your Full Name*Please enter your full name to confirm your electronic signature. Subscribe to updates By clicking this box, I agree to receive future communications regarding any MOVE with Autism Ontario programs. Δ
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