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Illness and physical condition

Does your child have any of the following conditions?

Asthma :

Epilepsy :

Respiratory cardio problem :

Allergy :

Mental health :

Diabetes :

Back problems :

Recent operation :

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Specification & medication

Emergency contact

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Second contact :

 

Discharge of responibility

Both personally and as a parent and / or guardian, with legal responsibility for my child, I consent to my child participating in all activities organized by ESM Canada, but without limitation. I release and release, for my part, and / or that of my child expressly, Mundialito Canada Sports School, any administrators, organizers and technical staff and their heirs, successors, entitled persons and successors, and the escorts, any liability, suit, claim and / or remedy of any nature whatsoever resulting from any damage, loss, theft, accident, bodily injury, death or otherwise resulting from the participation of my child in any activity organized by ESM Canada, including, but not limited to.

Authorization of publication

I authorize the ESM Canada organization to take photos and videos of my child and use them for promotions, contests and advertising purposes without any compensation. However, no photo may be used to infringe our privacy.

I acknowledge that I have carefully read and understood the scope of this release and publication release. I voluntarily agree to give up all my rights and remedies and those of my child against all the persons mentioned above.
I agree that this form serves as a contract between me and the ESM Canada organization and I am writing my name below as my signature.

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