IDialogue Ottawa

Survivor Games Registration Form

Parent Authorization Form

The Intercultural Dialogue Institute does not discriminate based on race, color, sex, handicap, religion or national origin. The Intercultural Dialogue Institute reserves the right at its sole discretion to refuse an application or dismiss a child from campsurvivor games. No refund will be made of fees if the child has attended any portion of the survivor games.
I understand and accept these guidelines Parent/Guardian's Signature:
I give The Intercultural Dialogue Institute permission to photograph and/or videotape my child for public relations and/or marketing purposes. Photos will remain archived at Intercultural Dialogue Institute and can be used for promotional purposes without notification.
I give permission for Intercultural Dialogue Institute to transport my child for the purpose of field trips and/or medical care. I understand that a schedule of events will be available to me and that all events are subject to change due to weather and/or scheduling conflicts without notice.
I authorize the management to act as the agent of the parents in any emergency situation or to administer basic first aid for the health and welfare of the children involved. I am responsible for the expenses involved if the services of a physician or hospital are required. Please request a waiver for persons requesting exemption from medical treatment.
By signing below I agree to adhere to all the Policies and Procedures set for by Intercultural Dialogue Institute.

Student's Medical Information Form

The medical background of each child is required as part of the project’s registration process. The project coordinator must be advised in writing of any condition that would limit the child’s ability to participate in any program.

Medical Conditions

Allergies

Please put N/A if your child does not have an allergy
Please put N/A if your child does not have an allergy
Please put N/A if your child does not have an allergy
Please put N/A if your child does not have an allergy
If yes, you must provide the competition with an Epi-pen to be kept at competition during your child’s enrollment. Epi-pen must be accompanied with a current prescription and a doctor’s note.