2016 Team Nunavut
Checklist
To participate in the 2016 Arctic Winter Games, as a member of Team Nunavut all
participants must complete the following requirements and submit to the Sport and
Recreation Division by January 25th, 2016;
Signed Team Nunavut’s Code of Conduct
Signed Team Nunavut Consent and Release Forms
Signed Host Society Consent form
Complete online participant registration (Available November 1st, 2015)
Headshot for accreditation
Acceptable Criminal Reference Check, and Vulnerable Sector Check
(Participants over age of 18)
 Copy of valid Nunavut Health Care Card
 Complete Online Registration
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All documents must be submitted by January 25th, 2016 at 5:00pm CST:
Sport and Recreation Division
SportProgramRegistration@gov.nu.ca
Fax: 1-867-793-3321
Please direct any questions to:
Jeff Seeteenak
Team Nunavut 2016
1-888-765-5506 (Toll Free) or 1-867-793-3308
jseeteenak@gov.nu.ca
1*Major Games include Arctic Winter Games, North American Indigenous Games, Canada Games , and Western Canada Games
PERSONAL INFORMATION
Full Name:
Last
First
M.I.
Address:
P.O Box #
City
Home Phone:
(
Province
)
Alternate Phone:
(
Birth Date:
Gender
Emergency Contact:
Phone Number:
Postal Code
)
Allergies/Conditions:
Medication/Emergency Treatment:
Health Care #:
Health Care Expiry:
Passport #:
Passport Expiry:
CONSENT FOR USE OF PERSONAL INFORMATION AND PHOTO RELEASE
1.
2.
I, the participant, authorize The Sport and Recreation Division/ Team Nunavut (collectively the “Organization”) to collect and
use personal information about me for communication purposes within Team Nunavut and the Government of Nunavut.
Furthermore, I grant permission to the Organization to photograph and/or record my image and/or voice on still or motion
picture film and/or audio tape, and to use this material to promote sport, recreation and physical activity through the media
of newsletters, websites, television, film, radio, print and/or display form. I understand that I waive any claim to
remuneration for use of audio/visual materials used for these purposes.
*We do not sell or distribute your personal information to any other third party not listed herein.*
____________________________________
Name of Participant
__________________
Date
____________________________________
Signature of Participant if over 18 or Parent Signature
ACCEPTANCE OF TERMS AND CONDITIONS
In consideration of the acceptance of my membership in the Organization, I agree as follows:
1.
2.
To abide by the policies (specifically Team Nunavut Code of Conduct), rules and regulations of the Organization.
I accept sole responsibility for my personal possessions and athletic equipment.
I acknowledge that I have read this registration agreement in its entirety and that I have executed this registration agreement
voluntarily.
By signing your name and dating below, you agree that you are to be bound by all that is contained in this Registration
Form.
____________________________________
Name of Participant
__________________
Date
2*Major Games include Arctic Winter Games, North American Indigenous Games, Canada Games , and Western Canada Games
INFORMED CONSENT AND ASSUMPTION OF RISK AGREEMENT
(FOR THOSE UNDER THE AGE OF MAJORITY (19)
WARNING! By signing this document you will waive certain legal rights, including the right to sue in circumstances outlined in this
Agreement. Please read carefully.
Participant’s Name: ________________________________________ Date: _____________________________
1.
This is a binding legal agreement; therefore clarify any questions or concerns before signing. As a Participant of Team Nunavut
events, programs, competitions, travel, and activities organized, operated or conducted and/or sanctioned by the Government
of Nunavut (collectively the “Events”), the undersigned, being the Participant and the Parent/Guardian of the Participant
(collectively the “Parties”) acknowledges and agrees to the following terms:
Disclaimer
2.
The Sport and Recreation Division/ Team Nunavut and its directors, officers, mission staff, committee members, members,
employees, volunteers, participants, agents and representatives (collectively the “Organization”) are not responsible for any
injury, personal injury, damage, property damage, expense, loss of income or loss of any kind suffered by a Participant during,
or as a result of, the sport and any Events, caused by the risks, dangers and hazards associated with participating with Team
Nunavut.
Description of Risks
3.
4.
The Participant is participating voluntarily in their sport or any Events of the Organization. In consideration of my participation,
the Parties hereby acknowledge that they are aware of the risks, dangers and hazards and may be exposed to such risks,
dangers and hazards. The risks, dangers and hazards include, but are not limited to, injuries from:
a) Sport
b) Vigorous physical exertion, strenuous cardiovascular workouts and rapid movements;
c) Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment;
d) Contact, colliding, falling or being struck by other participants or equipment;
e) Spinal cord injuries which may render me permanently paralyzed;
f) Travel to and from Events which are an integral part of the Organization's Events.
Furthermore, I am aware:
a) That injuries sustained can be severe;
b) That I may experience anxiety while challenging myself during the activities, events and programs;
c) That I may come into close contact with other participants;
d) That my risk of injury is reduced if I follow all rules established for participation; and
Release of Liability
5.
In consideration of the Organization allowing the Participant to participate, the Parties agree:
a) To freely accept and fully assume all such risks, dangers and hazards and possibility of personal injury, death, property
damage, expense and related loss, including loss of income, resulting from sport or any Events;
b) To forever release the Organization from any and all liability for any and all claims, demands, actions and costs that might
arise out of the Participant’s participation in competition or any Events, or from any breach of contract.
Acknowledgement
6. The Parties acknowledge that they have read this agreement and understand it, that they have executed this agreement
voluntarily, and that this Agreement is to be binding upon themselves, their heirs, executors, administrators and
representatives.
____________________________
_____________________________________
_____________
Printed Name of Participant
Signature of Participant
Date of Birth
___________________________
Printed Name of Parent or Guardian
_____________________________________
Signature of Parent or Guardian
_______________
Date
3*Major Games include Arctic Winter Games, North American Indigenous Games, Canada Games , and Western Canada Games
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT
(FOR THOSE 19 YEARS OF AGE AND OLDER)
7.
WARNING!
By signing this document you will waive certain legal rights, including the right to sue. Please read carefully.
This is a binding legal agreement; therefore clarify any questions or concerns before signing. As a Participant of Team Nunavut
and/or the events, programs, competitions, travel, and activities organized, operated or conducted and/or sanctioned by The
Government of Nunavut (collectively the “Events”), the undersigned acknowledges and agrees to the following terms:
Disclaimer
8. The Sport and Recreation Division and its directors, officers, committee members, members, employees, volunteers,
participants, agents and representatives (collectively the “Organization”) are not responsible for any injury, personal injury,
damage, property damage, expense, loss of income or loss of any kind suffered by a Participant during, or as a result of, the
Events, caused in any manner whatsoever including, but not limited to, the negligence of the Organization.
 I have read and agree to be bound by paragraphs 1 and 2.
Description of Risks
9. I am participating voluntarily in Team Nunavut’s Major Games Program and the Events. In consideration of my participation, I
hereby acknowledge that I am aware of the risks, dangers and hazards associated with or related to the Team Nunavut’s Major
Multi Sport Games Program and the Events. The risks, dangers and hazards include, but are not limited to, injuries from:
a) Exerting and stretching various muscle groups;
b) Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment;
c) Contact, colliding, falling or being struck by other participants or equipment;
d) Spinal cord injuries which may render me permanently paralyzed;
e) Travel to and from Events which are an integral part of the Organization's Events.
10. Furthermore, I am aware:
e) That injuries sustained can be severe;
f) That I may experience anxiety while challenging myself during the activities, events and programs;
g) That I may come into close contact with other participants;
h) That my risk of injury is reduced if I follow all rules established for participation; and
Release of Liability and Disclaimer
11. In consideration of the Organization allowing me to participate, I agree:
c)
To freely ACCEPT AND FULLY ASSUME all such risks and possibility of personal injury, death, property damage, expense and
related loss, including loss of income, resulting from my participation in the activities, events and programs of the
Organization; and
d) To FOREVER RELEASE the Organization from any and all liability for any and all claims, demands, actions, damages (including
direct, indirect, special and/or consequential), losses, actions, judgments, and costs (including legal fees) (collectively, the
“Claims”) which I may have or may in the future, that might arise out of, result from, or relate to my participation in the
Major Games program my presence at any venue, the Events, activities or programs of the Organization, and/or my
traveling to or from the Events, activities or programs of the Organization, even though such Claims may have been caused
by any manner whatsoever, including but not limited to, the negligence, gross negligence, negligent rescue, omissions,
carelessness, breach of contract and/or breach of any statutory duty of care of the Organization.
 I have read and agree to be bound by paragraphs 3 -5.
Acknowledgement
12. I acknowledge that I have read and understand this agreement, that I have executed this agreement voluntarily, and that this
agreement is to be binding upon myself, my heirs, spouse, children, parents, guardians, next of kin, executors, administrators
and legal or personal representatives.
____________________________________
Name of Participant (Please Print)
____________________________________
Signature of Participant
_____________________
Date
4*Major Games include Arctic Winter Games, North American Indigenous Games, Canada Games , and Western Canada Games
Travel Consent Form for Minors Travelling Abroad
To whom it may concern,
,
I / We,
full name(s) of parent(s) / person(s) / organization giving consent
Address:
street address, city
province/state, country
Telephone and email:
telephone
email
am / are the parent(s), legal guardian(s) or other authorized person(s) or organization with custody rights, access rights or
parental authority over the following child:
Information about travelling child
Name:
child’s full name
Date and place of birth:
dd/mm/yyyy
city, province/territory
number
dd/mm/yyyy
Number and date of issue of passport :
Issuing authority of passport:
country where passport was issued
Birth certificate registration number
number
Issuing authority of birth certificate
province / territory where birth certificate was issued
Contact information during trip
I / We give our consent for this child to travel with Team Nunavut to participate in the 2016 Arctic Winter Games
Destination(s):
Travel dates:
Nuuk, Greenland
name of destination country / countries
March 4th, 2016 – March 12th, 2016
date of departure to date of return
to stay with / at (if applicable)
name of person with whom child will be staying (Coach)
This letter may be signed before a witness who has attained the age of majority (18 or 19, depending on the province or territory of residence) OR certified
by an official who has the authority to administer an oath or solemn declaration (recommended).
or Signature of official
Signature(s) of person(s) giving
Signature of witness
consent
Signed before me on this
full name of witness
day of
,
month
signature(s) of person(s) giving consent
signature of witness
dd/mm/yyyy
dd/mm/yyyy
,
year
by
name(s) of person(s) giving consent
city,
province/territory
signature of official
name / title of official
5*Major Games include Arctic Winter Games, North American Indigenous Games, Canada Games , and Western Canada Games