Master Adult’s Product

$225.00

  • Participant Details

  • NamePhone numberEmail 

  • Medical Information

  • Epinephrine Administration Policy

  • The registrant is responsible for carrying his/her EpiPen or inhaler with him/her at all times. The registrant will show the staff where it is carried. The use of a fanny pack has proven the most successful way to do this. In the event of an emergency, the staff will administer the registrant's EpiPen. Please sign here to indicate you agree with this policy:
  • Clear Signature
  • Select date YYYY slash MM slash DD

  • Permission for Registrant to Participate in the Program

  • Photography

    nn

    We would like to photograph the program in action. These photographs will be used in the following manner:

    nn
      n
    • In the Art Centre newsletter At Agnes.
      • n
    • As publicity photographs.
      • n
    • For documentation of our programs, use in future funding applications and reports, and use in educational workshops.
      • n
    • On our website and in social media.
      • n
    nn

    The participant will not be individually identified in reproductions for these purposes.

  • Statement of Release from Liability

    nn

    I release Queen’s University from liability arising from injury, damages, or loss which may occur as a result of the registrant in the program, except those caused by neglect.

  • Clear Signature
  • Select date MM slash DD slash YYYY
  • Cancellation Policy:n
    Up to two weeks prior to start of the course or camp: full refund less $75.00 administration fee. Less than 14 days prior to start of the course or camp: 50% of fee. Less than 48 hours prior to start of the course or camp: no refund.nn
    Collection of Information:n
    Queen’s University requires that we collect the participant information requested in the forms. This information will be handled confidentially, and is collected solely for the purpose of providing a safe course for your child.

  • Registration Total

  • This field is for validation purposes and should be left unchanged.
SKU: MAP-2017 Category: