MEDIA CONSENT FORM
I, the undersigned, agree to participate in the activities below, at the request of the West Halifax Cheerleading, Inc. (hereafter
“WHC”)
…for the purposes of the project:
• Video Interview
• Audio Interview
• Text Interview
• An audio interview (including a photograph)
• A text interview (including a photograph)
• The creation or production of an audio,
video or text interview
• Photographs/images
(hereafter the “Interview”).
WHC may use the Interview for any purposes related to the promotion of its activities. This includes, without limitation, posting
the Interview on websites or in any other promotions, advertisements or communications whatsoever.
WHC may, at its sole discretion, edit the pictures of me and modify them as applicable and required for the purposes
authorized herein.
I understand that WHC will be the sole owner of any intellectual property rights, including copyright, that may subsist on the
Interview.
I hereby authorize WHC to use my name, image, voice, and likeness in relation to the exploitation of the Interview as may be
applicable and required for the purposes authorized herein, the whole without any limitation of time, territory, media, support
or language. I furthermore authorize this interview to be displayed, potentially to large audiences.
WHC may assign, transfer or license, in whole or in part, without limitation, the rights granted herein.
I acknowledge that this Consent is given without monetary consideration and that no amount of money may be claimed by
myself, or by any third party representing me, with regard to this consent to the use of the Interview.
I have full authority to sign the present Consent and I have requested that it be drafted in English
IN WITNESS WHEREOF, I have signed this Consent on the date indicated below.

CHEER NOVA SCOTIA

INFORMED CONSENT AND ASSUMPTION OF RISK AGREEMENT

FOR THOSE UNDER THE AGE OF MAJORITY (18 and Under)

WARNING!

By signing this document you will waive certain legal rights, including the right to sue. 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 in the sport of cheerleading and the programs, competitions, travel and activities organized, operated or conducted and/or sanctioned by Cheer Nova Scotia (collectively the “Events”), the undersigned, being the Participant and/or the Parent/Guardian of the Participant (collectively the “Parties”) acknowledges and agrees to the following terms:

Disclaimer

2.       Cheer Nova Scotia and its directors, officers, committee members, members, employees, volunteers, participants, agents and representatives (collectively the “Association”) 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 of cheerleading or any Events, caused by the risks, dangers and hazards associated with the sport of cheerleading or the Events.

We have read and agree to be bound by paragraphs 1 and 2.

Description of Risks

3.       The Participant is participating voluntarily in the sport of cheerleading and/or the Events.  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)       Executing strenuous and demanding physical techniques;

b)       Dryland training including weights, running and massage;

c)       Vigorous physical exertion, rapid movements, quick turns and stops, and strenuous cardiovascular workouts;

d)       Exerting and/or stretching various muscle groups;

e)       Collisions with walls, any cheerleading apparatus, floors or mats;

f)        Falling, tumbling or hitting any cheerleading apparatus, the floor, mats, ceiling, stands, equipment or other surfaces;

g)       Physical contact with other participants (including spotters whose role is to enhance safety and learning);

h)       Failure to properly use any cheerleading apparatus;

i)         Failure to participate within one’s abilities;

j)        The mechanical failure of any cheerleading apparatus;

k)       Spinal cord injuries which may render me permanently paralyzed; and/or

l)        Travel to and from competitive events and associated non-competitive events which are an integral part of the Association’s activities. 

4.       Furthermore, the Parties are aware:

a)       That injuries sustained can be severe;

b)       That the Participant may experience anxiety while challenging themselves during the sport of cheerleading and the Events;

c)       That the Participant’s risk of injury is reduced if they follow all rules established for participation; and

d)       That the Participant’s risk of injury increases as they become fatigued.

Release of Liability

5.       In consideration of the Association allowing the Participant to participate, the Parties agree:

a)       That the Participant’s physical condition has been verified by a medical doctor to participate;

b)       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 the sport of cheerleading and/or any Events;

c)       To forever release the Association from any and all liability for any and all claims, demands, actions and costs that might arise out of the Participant’s participation in the sport of cheerleading or any Events. 

We have read and agree to be bound by paragraphs 3 -5.

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.