Registration and Risk Acceptance FRENCH VERSION REGISTRATION AND RISK ACCEPTANCE Please complete one form per address. All participants must reside at the same address. Participant 1Name* First Name Name Date of Birth* YYYY MM DD Email* Physical condition 1If the answer is YES to a question, check the box. Are you pregnant? Do you suffer from vertigo? Do you have heart problems? Have you ever had a concussion? Do you have physical disorders? Other Please specify the "other" physical conditionParticipant 2 Add another participantParticipant 2Name First name Name Date of birth YYYY MM DD Email Physical conditionIf the answer is YES to a question, check the box. Are you pregnant? Do you suffer from vertigo? Do you have heart problems? Have you ever had a concussion? Do you have physical disorders? Other Please specify the "other" physical conditionParticipant 3 Add another participantParticipant 3Name First Name Name Date of birth YYYY MM DD Email Physical conditionIf the answer is YES to a question, check the box. Are you pregnant? Do you suffer from vertigo? Do you have heart problems? Have you ever had a concussion? Do you have physical disorders? Other Please specify the "other" physical conditionParticipant 4 Add another participantParticipant 4Name First Name Name Date of birth YYYY MM DD Email Physical conditionIf the answer is YES to a question, check the box. Are you pregnant? Do you suffer from vertigo? Do you have heart problems? Have you ever had a concussion? Do you have physical disorders? Other Please specify the "other" physical conditionParticipant 5 Add another participantParticipant 5Name First Name Name Date of birth YYYY MM DD Email Physical conditionIf the answer is YES to a question, check the box. Are you pregnant? Do you suffer from vertigo? Do you have heart problems? Have you ever had a concussion? Do you have physical disorders? Other Please specify the "other" physical conditionParticipant 6 Add another participantParticipant 6Name First Name Name Date of birth YYYY MM DD Email Physical conditionIf the answer is YES to a question, check the box. Are you pregnant? Do you suffer from vertigo? Do you have heart problems? Have you ever had a concussion? Do you have physical disorders? Other Please specify the "other" physical conditionAddressAddress* Province / State Postal / Zip Code CountryCanadaUnited States—AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo {Democratic Rep}Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland {Republic}IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, {Burma}NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwePerson to contact in case of emergencyName (Emergency)*Phone Number (Emergency)*QuestionsPromotions and rebates I want to receive via email rebates, promotions and other information related to Voiles en Voiles.How did you hear about us? Facebook and Social Networks Word of mouth Passing nearby Billboard or in the subway Television Radio Magazine, Newspaper Search on the Internet Please check all that applyDId you plan on coming to Voiles en Voiles today? Yes No Did you come by car Yes No Risk acceptanceI, the undersigned, recognize and agree to the terms listed below: Any activity at Voiles en Voiles including aerial courses, climbing, slides, inflatable games, multimedia theater, archery tag and events as well as the use of the related equipment (hereinafter “Activities”) entails considerable elements of risk. I confirm that I am in good physical health and that I have no health problems that stop me from participating in Voiles en Voiles’ Activities. I acknowledge that if I answered yes to any question regarding my physical condition, I should not take part in the Activities. I acknowledge that I have been informed and that I am aware of the risks and dangers associated with the Activities. These risks include, but are not limited to: (1) performing demanding physical effort; (2) falling or colliding with the games, the equipment, the ground or other participants; (3) mechanical defects or improper use of any piece of equipment. In addition, I have been informed, I am aware and I accept the risks that the Activities may cause, such as the loss or damage of your belongings, an accidental injury, or in extreme cases, permanent trauma or death. For the safety of everyone, I acknowledge and commit to respect the rules and regulations of Voiles en Voiles, a copy of which is displayed at the service kiosk, and to follow all of the orders and instructions given by the employees of Voiles en Voiles. In addition, I take the responsibility to assume the cost to repair or replace borrowed equipment in the case of breakage or loss. I authorize Voiles en Voiles to use, for advertising ends, all representations in the form of video or photographical images in which I may appear. I acknowledge and agree to assume all of the risks associated with participation at Voiles en Voiles and to release Voiles en Voiles, its directors, employees, participants, owners and representatives from all responsibility, loss, damages, judgments, claims or proceedings of any kind, whether or not the fault is a result of the negligence of Voiles en Voiles. I acknowledge that I have read and understood all the measures and procedures put in place by the company to reduce and control the risk of COVID-19 infection. I understand that these are mandatory and that I must comply with them. I also understand that in order to protect the health, safety and physical integrity of its customers and employees, the company must ensure that the measures in place are applied and that it must intervene in the event of a defect. I acknowledge that I have read, understood and accepted all of the terms and conditions set forth in the current risk acceptance and that I am participating in the Activities of my own free will, without any other influences. Signature for participants, parents or tutors** I acknowledge that I am in a position of authority over the child of less than 16 years of age that I am signing for (hereinafter “Child”) and that: (i) I am the parent/guardian of the Child; or (ii) I have custody of the Child and I have obtained the parents’/guardians’ consent to participate in Voiles en Voiles and to sign the current risk acceptance and its conditions in their name and in the Child’s name.Date MM slash JJ slash AAAA Signature - Participant 1Signature - Participant 2Signature - Participant 3Signature - Participant 4Signature - Participant 5Signature - Participant 6
