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Georgetownarmycadets.ca

RETURN THIS FORM WITH PAYMENT (if applicable) CATO 14-06 Cross Country Ski & Snowshoe Day
CONSENT AND RELEASE OF LIABILITY
WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNIFICATION
AGREEMENT
1. By my signature, I, ____________________________________________ (print full name), the parent or
legal guardian of ______________________________________ (print full name), a member of the Royal
Canadian Army Cadets, realizing the potential hazards associated with travelling away from the cadet 676 locality
of Georgetown and taking part in cadet activities and training, on behalf of myself and him/her (cross out non
applicable)
, and my and his/her (cross out non applicable) heirs, devisees, successors, assigns, executors and
administrators, in consideration of him/her (cross out non applicable) being permitted to participate in a trip to:
Destination: Mansfield Outdoor Centre
Activities of Significance: Cross Country Skiing / Snowshoeing and outdoor activities

Sunday 23 Feb
Method of Transport:
Cost per Cadet: None
Additional Information:
Cadets must be dressed appropriately for the weather
See website for complete kit list
Lunch will be provided
or any other activities related to this trip, hereby:
a. acknowledge having read the terms and conditions of this optional activity not funded by the Department of
National Defence and indicate my understanding and acceptance;
b. accept/do not accept that my son/daughter/ward will occasionally have "FREE TIME" without direct
supervision;
Do Not Accept:
(Initial Applicable)

c. give the (Commanding Officer/Officer-in-Charge/Medical Officer/Nurse/First Aider)permission to authorize
emergency medical treatment if required for my son/daughter/ward;
d. having determined that the activities involve potential hazards and may result in physical harm and wishing in
any event him/her (cross out non applicable) to carry out the activity voluntarily assume any risks that may be
associated with the activity;
RETURN THIS FORM WITH PAYMENT (if applicable) CATO 14-06
e.
waive all claims of any nature or kind whether in contract, tort, negligence or otherwise, against Her Majesty
the Queen in right of Canada, Her officers, servants, agents, employees and members of Her Canadian Forces the
Cadet League its officers, servants, agents, employees and members and the 676 Support Committee, its officers,
servants, agents and members all in their employment and private capacities, in any manner arising out of, based
upon, occasioned by or attributable to the activities of them, including negligence on their part, or any action
taken or things done or maintained by virtue thereof;

Signature of Parent/Guardian Date
MEDICAL
2
. Parents/Guardians are requested to initial if they agree or disagree to have the medications listed
below administered if necessary by the (Commanding Officer/Officer-in-charge/Medical
Officer/Nurse/First Aider
) to their son/daughter/ward during the course of the trip.
TYLENOL 325 mg tablets for pain or fever will be administered according to package directives.
Disagree:
(Initial applicable)
IBUPROPHEN tablets for pain relief, muscle pain or fever will be administered according to
package directives.
Disagree:
(Initial applicable)
GRAVOL 50 mg tablets for travel nausea will be administered according to package directives.
Disagree:
(Initial applicable)
DIPHENHYDRAMINE (BENADRYL) for symptoms of allergic rhinitis, motion sickness and insect
bites and stings will be administered according to package directives
Disagree:
(Initial applicable)
ROBITUSSIN DM syrup for cough suppression will be administered according to package directives.
Disagree:
(Initial applicable)
3. Cadets travelling with prescription drugs are requested to list them below.
Prescribed Medication

4. Cadets are requested to provide a list of their known allergies

Source: http://www.georgetownarmycadets.ca/Cross%20Country%20Skiing.pdf

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