I authorize the Canada Senior Games Association and the 2010 Canada 55+ Games Organizing Committee to administer such care, as may be required for me by medically qualified personnel during my participation in any event of the Canada Senior Games Association's National Games. Furthermore, I hereby declare that the above information is true and complete to the best of my knowledge. I understand that a false statement may disqualify me from further consideration as a volunteer or result in dismissal.

In consideration of my involvement with the 2010 Canada 55+ Games, I personally and on behalf of my heirs, executors, administrators and assigns, hereby release and forever discharge the following: a. The Canada Senior Games Association, b. The Volunteer Bureau of Leeds Grenville, c. The Corporation of the City of Brockville and other partnering municipalities, e. All sponsors, organizers, venues, and volunteers of 2010 Canada 55+ Games, their respective officers, directors, agents, representatives or successors, from any and all claims or demands that I have or my heirs, executors, administrators, assigns or any third party may have for personal injury and property damage of any nature whatsoever, arising by reason of my participation at any level of the 2010 Canada 55+ Games event. Furthermore, I give the 2010 Canada 55+ Games and event partners, permission to use my likeness in any marketing and promotional photography and imagery without prior notification and waive any compensation.

I have read the above statement, understand it, and my signature confirms its acceptance. I attest and verify that I have full knowledge of the risks involved in my participation and that I am physically fit and able to participate in the said games.