Camp Intake Form
Once this sign up form is completed an invoice will be emailed to you within 24 hours.
*Cancelations: a full refund will be given minus processing fees if canceled 72 hours prior to start date. Within 72 hours a 75% refund will be given. Within 24 hours a 50% refund will be given. No refunds beyond this point.
MARIKA KONCEK doing business as The Dog LISTENER
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISK AND INDEMNITY (the “Agreement”)
| WARNING - BY SIGNING THIS FORM YOU ARE ASSUMING BOTH PHYSICAL AND LEGAL RISKS WHICH HAVE FINANCIAL IMPLICATIONS TO YOU AND/OR YOUR FAMILY, AND YOU ARE WAIVING IMPORTANT LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION. PLEASE READ CAREFULLY!
TO: Marika Koncek, doing business as The Dog Listener, and its employees, agents, contractors and volunteers, and their respective personal representatives, successors and assigns (collectively, “The Dog Listener”), for participation by me and/or my dog in sessions or events organized or conducted by The Dog Listener, including, but not limited to, dog walking (on or off leash), group dog walks, dog training, or dog sitting; use of equipment owned or provided by The Dog Listener(the “Equipment”); use of land, trails, facilities, and accommodation operated or arranged by The Dog Listener (the “Facilities”); and transportation to, from, or during the any of the above activities (all or any part of the above being called the “Activities”)
I am aware that participating and allowing my dog to participate in the Activities involves many inherent risks, dangers, and hazards. I assume full responsibility for all such risks, including, but not limited to risk of serious injury or death that may be caused to me or my dog by, but is not limited to, unpredictable and untrained dogs; my dog or other dogs biting or attacking me or others; risk of illness or infection from dog bites; injury to my dog from its own actions or bites or scratches from other dogs; Facility conditions including, but not limited to, uneven or damaged terrain, the presence of moisture or mud, obstacles and obstructions upon or under the terrain and other natural or manmade conditions which may be hazardous to me or my dog; exposure to danger in remote wilderness areas without supervision or access to food, water, or medical care; misuse, malfunction or failure of the Equipment, or my or other participants’ equipment; impact or collision with other participants or dogs; negligence of other participants; andnegligence of The Dog Listener, including the failure of The Dog Listener to take reasonable steps to safeguard or protect me from risks, dangers and hazards of participating in the Activities. I freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury, death, permanent disability, property damage, loss of income or loss resulting therefrom.
I understand and acknowledge the risk and danger inherent in the Activities and acknowledge that the Activities are physically and mentally demanding. I am participating voluntarily and with the understanding that I am entirely responsible for my and my dog’s well-being during participation in the Activities.
RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND INDEMNITY
In consideration of my participation in the Activities, and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I hereby further agree as follows:
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I WAIVE ANY AND ALL CLAIMS that I have or may have against The Dog Listener and RELEASE The Dog Listener from any and all liability for any loss, damage, expense, or injury, including death, that I may suffer, or that my family or next of kin may suffer as a result of my or my dog’s participation in, or in any way connected with, the Activities DUE TO ANY CAUSE WHATSOEVER, INCLUDING 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, AND FURTHER INCLUDING THE FAILURE OF The Dog Listener TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN THE ACTIVITIES.
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I AGREE TO HOLD HARMLESS AND INDEMNIFY The Dog Listener from any litigation expense, legal fees (on a solicitor and own client basis), liability, damages, awards, costs, and expenses of any type whatsoever that result from my or my dog’s participation in the Activities, including any such expense that may arise from a claim brought by a third party because of my dog’s actions while under the supervision of The Dog Listener.
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I AGREE NOT TO SUE The Dog Listener for any loss, injury, costs or damages of any form or type arising directly or indirectly from my participation in the Activities.
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I Agree that I am solely responsible for determining my own and my dog’s own health, fitness, and ability to complete the Activities; determining the quality, fitness for the intended purpose, and safety and proper use of the Facilities and/or the Equipment; for determining what equipment is necessary for participating in the Activities or using the Facilities and/or the Equipment; and for obtaining and using that equipment in conjunction with the Activities, Facilities and/or the Equipment. I acknowledge that even if The Dog Listener requires any party to complete skill tests, requests proof of any party’s capacity to complete the Activities, or requires certain equipment be used or carried during the Activities, The Dog Listener makes no representations, conditions or warranties as to my or my dog’s skills or abilities, or the skills, experience, or equipment which are necessary to safely participate in the Activities – such matters are my sole responsibility. Further, The Dog Listener makes no representations, conditions, or warranties as to the temperament or behaviour of other dogs or people, nor the quality, fitness for the intended purpose, safety, manufacture, maintenance or use of the Facilities and/or the Equipment.
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I acknowledge and RepRESENT that my dog and I are in good physical and mental condition and that I will be able to complete the Activities safely. If at any time during the Activities my or my dog’s continued participation risks causing any form of physical or mental harm to myself, my dog, or others, I will inform The Dog Listener of the condition and discontinue my and/or my dog’s participation immediately. I acknowledge and confirm that I will observe the condition of co-participants (if any) and, if the physical health of any such co-participants appears compromised, I will inform The Dog Listener of such condition.
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The Dog Listener can take all reasonable steps to respond to a medical or other emergency that may arise out of my or my dog’s participation in the Activities, including but not limited to providing first aid and obtaining medical or veterinary assistance as may be required, and I will pay for all costs of any such emergency response.
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IMAGE AND NAME RELEASE. I grant to The Dog Listener all right, title and interest in and to any videotape, slides, photographs, film or other reproduction of my image in any format whatsoever captured in connection with my participation in the Activities (the “Images”) and I grant The Dog Listener the non-exclusive right to use the Images and my name in results and promotional materials, including broadcasting, advertising, trade shows, exhibitions, websites, and training materials.
- The Dog Listener may from time to time at its discretion revoke my privileges to attend at the Facilities and/or to participate in the Activities.
- This Agreement shall be binding and effective on my heirs and personal representatives.
- If any portion of this Agreement is declared or held to be invalid for any reason, the invalidity will not affect the validity of the remainder of this Agreement which will continue in full force and effect and be construed as if this Agreement had been executed without the invalid portion.
- This Agreement shall be governed by and construed in accordance with the laws of British Columbia and the laws of Canada applicable therein. All parties to this Agreement irrevocably submit to the jurisdiction of the Courts of British Columbia and agree to bring all litigation relating to this Agreement in British Columbia.
In entering into this Agreement, I am not relying on any oral or written representation or statement made by The Dog Listener EXCEPT AS set forth in this Agreement. I HAVE READ AND UNDERSTOOD THIS AGREEMENT BEFORE SIGNING IT, AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS AND PERSONAL REPRESENTATIVES MAY HAVE AGAINST The Dog Listener.
ADULT WAIVER FOR MINOR PARTICIPATION
(MUST BE COMPLETED FOR PARTICIPANTS UNDER 19)
WARNING - BY SIGNING THIS FORM YOU ARE ASSUMING BOTH PHYSICAL AND LEGAL RISKS WHICH HAVE FINANCIAL IMPLICATIONS TO YOU AND/OR YOUR FAMILY, AND YOU ARE WAIVING IMPORTANT LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION!
PLEASE READ CAREFULLY!
In consideration for allowing my minor child/ward to participate in the related events and activities of The Dog Listener ATHLETICS INC., I hereby warrant and agree:
- I am the parent/guardian having full legal responsibility for decisions regarding my minor child/ward; and
- I have reviewed the RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISK AND INDEMNITY (the “Agreement”) attached to this document;
- I am familiar with and accept, on behalf of myself and my minor child/ward that there are risks to my child’s participation in the Activities, as set out in the Agreement, and that in particular, there is a risk of serious injury and death from participating in fitness training and activities; and
- I have satisfied myself and believe that my minor child/ward is physically, emotionally and mentally able to participate in the Activities, and that his/her equipment is mechanically fit for his/her use in this Activities; and
- I understand, and will instruct my minor child/ward, that all applicable rules for participation must be followed and that at all times the sole responsibility for personal safety remains with me and my minor child/ward, as set out in the Agreement; and
- I will immediately remove my minor child/ward from participation and notify the nearest The Dog Listener representative if at any time I sense or observe any unusual hazard or unsafe condition or if I feel that my minor child/ward has experienced any deterioration in his/her physical, emotional or mental fitness for continued participation in the Activities.
- I authorize The Dog Listener to consent to emergency medical treatment in accordance with the best interests of my minor child/ward, should I not be present at the relevant time to grant consent myself.
I UNDERSTAND AND AGREE, ON BEHALF OF MY MINOR CHILD/WARD, HIS/HER HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES AND NEXT OF KIN, MYSELF, MY HEIRS, ASSIGNS, PERSONAL REPRESENTATIVES AND NEXT OF KIN THAT MY EXECUTION OF THIS DOCUMENT CONSTITUTES:
1. AN UNQUALIFIED ASSUMPTION OF ALL RISKS associated with participation in this event by my minor child/ward even if arising from negligence or gross negligence, including any compounding or aggravation of injuries caused by negligent first aid operations or procedures, of the event organizer, the event venue and any persons associated therewith or participating therein; and
2. A FULL AND FINAL RELEASE AND WAIVER OF LIABILITY AND ALL CLAIMS that I have or may in the future have against The Dog Listener (as defined in the Agreement) from any and all liability for any loss, damage, injury or expense that my minor child/ward may suffer, or that his/her next of kin may suffer as a result of his/her use of or presence at, the Facilities, due to any cause whatsoever, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE RELEVANT OCCUPIERS LIABILITY ACT OR ANY OTHER RELEVANT STATUTES, on the part of the The Dog Listener.
3. AN AGREEMENT NOT TO SUE The Dog Listener for any loss, injury, costs or damages of any form or type, howsoever caused or arising, and whether directly or indirectly from the participation of my minor child/ward in the event; and
4. AN AGREEMENT TO INDEMNIFY, and to SAVE and HOLD HARMLESS The Dog Listener, and each of them, from any litigation expense, legal fees, liability, damage, award or cost, of any form or type whatsoever, they may incur due to any claim made against them or any one of them whether the claim is based on the negligence or the gross negligence of The Dog Listener or otherwise.
5. AN ACKNOWLEDGMENT that I HAVE READ THIS DOCUMENT THOROUGHLY.
