Thank You – March Break Bash 2025

PHOTOGRAPHY/MEDIA CONSENT AND RELEASE

Empower Simcoe sometimes asks people to let us use their photo, video or audio to promote Empower Simcoe’s work or
tell others what we do.

I understand that a photo, video or social media posting may appear in public promotional material for many years.
Empower Simcoe may, at any time, reproduce, publish and/or republish the video, photograph(s) or audio for
any communication, advertising and/or promotional purposes, including the posting of the video or any portion thereof
on the agency’s websites.

This consent will remain valid for one year from the date signed.

Authorizing person(s) may cancel or change the above authorization in writing at any time prior to the expiry date, unless
action has already been taken on the basis of the authorization.

I hereby give my/our permission and consent to Empower Simcoe to collect and use Photography and/or Video of my child to promote and advertise the programs & services of Empower Simcoe.

WAIVER AND CONDITIONS OF ENROLMENT

1. The parent/guardian(s) of the above-named participant, release the March Break Bash program, its Youth Facilitator, Supervisor, Staff and Volunteers from any loss, personal injury, accident, misfortune or damage to the above-named or his/her property, with the understanding that reasonable precautions shall be taken to ensure the health and safety of the above-named participant.
2. All Medications Must Come Blister Packaged - please arrange for the youth’s medication to be blister packaged with your pharmacist and only bring what is required for the duration of the day camp. Blister Packaging: arranged at the pharmacy where each dose of medication is separated by time of day.  Please be advised that we ask this to ensure the safety of all youth and support staff involved at the March Break Camp, this policy helps reduce the risk of any medication error.
3. In case of medical emergency, the parent/guardian(s) of the above-named participant understands that every effort will be made to contact them. In the event that the parent/guardian cannot be reached, I/we give permission to the Empower Simcoe Staff and the attending doctor to secure medical treatment for and/or hospitalize the above-named participant.
4. Any Medical, Emotional or Behavioural Conditions Not Fully Disclosed on This Form Could Result in The Youth Being Excused from The March Break Bash.  In That Event, No Refund Will Be Issued.
5. REFUND POLICY: Cancellation more than two weeks prior to the start of the camp – full refund less $50.00 administration fee. Withdrawal during camp on physician’s order – one half of fee for unexpired term will be refunded. No refund will be made for dismissals due to disciplinary action, late arrivals or early departures.

I have read and hereby agree with the waivers and conditions of enrolment.