NOTE: Ecosource Mississauga does not accept paper waivers, please submit electronically.

Ecosource Participant/Volunteer Waiver Form

Thank you for your interest in participating/volunteering with Ecosource! All participants/volunteers MUST have a signed waiver in order to participate in program activities. If you are under 18 years old, please complete this form with the help of a parent or guardian.

Contact Information

Additional Information

Does the participant/volunteer have:

Any severe allergies to food or other substances?

Informed Consent & Assumption of the Risk and Waiver of Liability Relating to COVID-19

Please read the following carefully.

1. I have read and understood the information provided in this form about participating/volunteering for Ecosource. I hereby willingly consent to release Ecosource from all liabilities and waive all claims and demands arising from personal injuries incurred while participating/volunteering with Ecosource.
2. I understand that photographs, videos and/or evaluation may be taken of the participant/volunteer and may be used in the promotion of Ecosource. They may be published or used for any application in newspapers, magazines, film, television commercials, posters, slide presentations or otherwise displayed to the public or used for educational, fundraising, information or training purposes.
3. I understand that I will not receive any compensation for photographs or videos taken of the participant/volunteer during Ecosource activities.
4. Ecosource has put in place protocols and other preventative measures to reduce the likelihood of transmission of COVID-19 based on directives from Peel Public Health. However, I understand that Ecosource cannot guarantee or in any way represent that myself (or my family) will not become infected with COVID-19 through my participation in Ecosource programs. I also understand that access to Ecosource’s programs may increase the risk of contracting COVID-19.
5. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by participating in Ecosource’s programs and that such exposure or infection may result in personal injury, illness, permanent disability, and death.
6. I voluntarily agree to assume all of the COVID-19 risks and accept full responsibility for any injury to me, while participating in Ecosource programs including any claims, losses, personal injury, disability, death and any other health related COVID-19 risks. I agree to hold harmless, indemnify, defend and waive any liability against Ecosource from any direct or indirect damages, suits or claims including legal expenses sustained as a result of or in relation to any matters under this agreement or in consequence of any breach of any representation or obligation made herein.
7. I declare that I understand Ecosource’s protocols for participating in programs during COVID-19 and hereby agree to follow and adhere to those protocols.
8. I understand and agree that Ecosource may share my personal information (including my name and contact information) with other agencies, including Peel Public Health, for the express purpose to manage the spread of COVID-19. If it is necessary to disclose my personal information, I understand that I will be contacted in advance and provided the reason for disclosure, unless this is prohibited by law or regulation as determined by a public body.

Ecosource COVID-19 Protocols for Participant and Volunteers

• Please complete this COVID-19 self-assessment before attending an Ecosource activity. Stay home if you are feeling unwell.
• Practice physical distancing of at least 2 meters (6 feet). We encourage you to wear a mask when this is not possible.
• Practice personal hand hygiene. Wash and sanitize your hands upon entering and exiting an activity, as well as before and after using high touch surfaces.
• When food is part of a program or event, please follow the directions of staff to limit the sharing of food.
• Mask wearing:
  • Masks are encouraged for indoor activities but not required.
  • Please bring your mask with you and use as needed and according to your comfort level.

Please note that these protocols are reviewed on an ongoing basis and are subject to change.

Volunteers/Participants under the age of 18

I am the parent or legal guardian of the child(ren) named below. I have read the Informed Consent & Assumption of the Risk and Waiver of Liability Relating to COVID-19 and I understand the legal consequences of signing this document. I assume all risks of my child(ren)’s participation in Ecosource’s programs during COVID-19 and agree to waive any claims relating to their participation against Ecosource and their respective employees.

Fri Apr 19, 2024