PISE Informed Consent Agreement

Dear Parent / Guardian of Registrant:

Thank you for choosing to use the facilities, services or programs of PISE. We request your understanding and cooperation in maintaining both your and our safety and health by reading and signing the following INFORMED CONSENT.

I declare that my child, name listed below, intends to use some or all of the activities, facilities, programs and services offered by PISE and I understand that each person, my child included, has different capacities for participating in such activities, facilities, programs and services. I am aware that all activities, services and programs offered are educational, recreational, or self-directed in nature. I assume full responsibility before, during and after participation to instruct my child on the choices available to them relative to the risks to the undertaken, information or instructions available.

I understand that part of the risk involved in undertaking any activity or program is relative to one’s own state of fitness or health (physical, including, but not limited to any claims associated with communicable diseases, mental or emotional) and the awareness, care and skill with which my child conducts themselves in that activity or program. I acknowledge that my child’s choice to participate in any activity (including an inflatable playground), service and program of PISE brings with it the assumption by me of risks or results stemming from this/these choice(s) and the fitness, health, awareness, care and skill that my child possesses and uses. In addition, I understand that I am free to withdraw my child from, reduce or modify involvement in any program activity, and realize that I should do so upon recognition of any signs of transient light-headedness, fainting, chest discomfort, leg cramps, nausea, etc. I further understand that the activities, programs and services offered by PISE are sometimes conducted by personnel who may not be licensed, certified, or registered instructors or professionals. I accept the fact that the skills and competencies of some employees and/or volunteers will vary according to their training and experience and that no claim is made to offer assessment or treatment of any medical or physical condition by those who are not duly licensed, certified or registered and herein employed to provide such professional services.

In addition, I acknowledge that I have inquired about the nature of any activity, program or services that I am not completely familiar with and I have been informed of any inherent risks.

I recognize that PISE is not responsible for any lost or stolen items; PISE encourages participants to leave all valuables at home as we cannot guarantee consistent supervision.

I declare that I have read, understood and agree to the contents of this INFORMED CONSENT AGREEMENT in its entirety.


Personal Information Declaration

This information is collected for the administrative and/or operational functions of PISE as authorized by the Local Government Act. This information has been collected, and will be used and maintained in accordance with the Freedom of Information and Protection of Privacy Act. Should you have any questions about the above, please contact PISEs Privacy Office at 250-220-2512.

Signee Information

By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.