Participant Name

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Under 18

18-24

25-29

30-34

35-39

40+

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If participant is 18 or older, please enter "N/A"

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Participation Waiver, Release of Liability, and Media Release Form:

This waiver and release of liability pertains to the participation in the Pilates in the Park event, taking place on June 14, 2025, at Waterloo Park (west, 100 Westmount Rd N, Waterloo, ON N2L 3G5 and hosted by Keep Your Head Up Foundation (“the Organization”).

GENERAL WAIVER AND RELEASE OF LIABILITY:

I, the undersigned participant, acknowledge that my participation in the Pilates in the Park event is voluntary and involves physical activity that carries inherent risks. These may include but are not limited to injuries such as sprains, strains, fractures, collisions with other participants or equipment, uneven playing surfaces, or facility risks. I freely accept all such risks, dangers and hazards and recognize the possibility of experiencing abnormalities in mood, blood pressure or heart rate, ineffective heart function, fainting, muscle soreness, muscle strains, bruising, heart attack or cardiac arrest, stroke, personal injury, property damage, and/or death. I represent that I am in good health, physically fit, and have no known medical conditions that would affect my safe participation in this event. I understand that while the Organization has taken steps to ensure participant safety, it cannot eliminate all risks, and I voluntarily assume full responsibility for injury, loss, or damage arising out of participation. I am also aware that I may decide to discontinue participation at any time should I be in any distress, or for any other reason.

RELEASE, WAIVER, and INDEMNITY AGREEMENT

In consideration for being allowed to participate, I do herby waive, release, and discharge the Organization, its board of directors, employees, volunteers, agents, sponsors, and the event venue from any and all liability for personal injury, illness, disability, property damage, or death arising out of or in connection with my participation. I agree to indemnify and hold harmless the above-mentioned parties from any claims, demands, damages, or costs, including legal fees, resulting from my actions, negligence, or participation in the event. CODE OF CONDUCT

I agree to conduct myself in a respectful and responsible manner. I understand that any behaviour deemed unsafe, aggressive, discriminatory, or disruptive—may result in my immediate removal from the event.

MEDIA RELEASE *

I give permission to Keep Your Head Up Foundation and its representatives to take photographs, video, and audio recordings of me during the event for promotional, educational, and fundraising purposes in print and digital formats. I waive my right to compensation or approval of materials in which my image appears.

ACKNOWLEDGEMENT OF TERMS *

I have read and fully understand this waiver, release of liability, and consent form. I agree to its terms freely and voluntarily. I agree to give up or waive any right that I, myself, and/or a personal representative(s), may otherwise have to bring forward a legal action for personal injury, property damage, and/or death. I agree to the above terms.

How did you hear about this event? *

Social media

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Flyer

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