Valentine's Day Dinner - Mauricie & Centre-du-Québec

Identification

Adresse courriel(Required)

A confirmation of your registration and important information about the activity can be sent to you by email.

Name of my child who has been diagnosed(Required)

First Last

Is your child in treatment at this time?(Required)

Yes

End of treatment date(Required)

Participants

Name(Required)

First name Last name

Allergies or food restrictions(Required)

Yes

If yes, please specify:(Required)

Add a participant?

Yes

Name(Required)

First name Last name

Allergies or food restrictions(Required)

Yes

If yes, please specify:(Required)

Consent form for adults and children over 14 years old

Consent

I authorize that photos and videos taken of myself during the activity be used to represent Leucan's mission. I authorize that my name, images, voice and comments be used without limit of territory, media or language to promote Leucan's mission for a period of one year.

Consent(Required)

I agree to respect all instructions and guidelines of the activity organized by Leucan.

Consent(Required)

I acknowledge that my participation in the activity may involve risks, and I hereby assume and freely accept all risks arising from my participation in this activity. I acknowledge and accept that Leucan declines all responsibility for the risks that my participation in the activity may entail and that Leucan cannot be held responsible for any damages of any kind (physical, moral or material) that I may suffer in connection with my participation in this activity. Therefore, I agree to release and hold harmless Leucan, the event organizers, volunteers, sponsors, partners and their respective employees and agents present at this activity from any and all liability for loss, damage or injury to myself as a participant or to my property that may arise or occur in connection with my participation in this activity, and I waive all rights with respect to the foregoing.

Consentement(Required)

According to the policy in effect at Leucan, this activity will be alcohol-free.

I, the undersigned, (name of the participant), accept the terms and conditions of this activity.

First name Last name

Consent for another participant over 14 years old

Yes

Consent

Consent(Required)

I agree to respect all instructions and guidelines of the activity organized by Leucan.

Consent(Required)

Consentement(Required)

According to the policy in effect at Leucan, this activity will be alcohol-free.

I, the undersigned, (name of the participant), accept the terms and conditions of this activity.

First name Last name

Valentine's Day Dinner - Mauricie & Centre-du-Québec

Registration form - Valentine's Day - Mauricie CDQ

Identification

Participants

Consent form for adults and children over 14 years old

Partners

Valentine's Day Dinner - Mauricie & Centre-du-Québec

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Registration form - Valentine's Day - Mauricie CDQ

Identification

Participants

Consent form for adults and children over 14 years old

Partners