Child that has received a cancer diagnosis Name
First name
Last name
Is your child currently undergoing treatments? Does your child have any allergies or intolerances?(Required) Is an Epipen needed? Diet and food preferences: check if applicable. Does your child have any other health problems that require special attention?
Ex. mobility problems, anxiety, depression, chronic pain, etc.
Please add any details, lifestyle issues or conditions that might help us to know and understand your child better. Together, we can ensure that you get the most out of your stay.:
Participants Name(Required)
First name
Last name
Does this participant have any allergies or intolerances?(Required) If yes, please specify:(Required)
Is an Epipen needed? Diet and food preferences: check if applicable. Add a participant ? Name(Required)
First name
Last name
Does this participant have any allergies or intolerances?(Required) If yes, please specify:(Required)
Is an Epipen needed? Diet and food preferences: check if applicable. Add a participant ? Name(Required)
First name
Last name
Does this participant have any allergies or intolerances?(Required) If yes, please specify:(Required)
Is an Epipen needed? Diet and food preferences: check if applicable. Add a participant ? Name(Required)
First name
Last name
Does this participant have any allergies or intolerances?(Required) If yes, please specify:(Required)
Is an Epipen needed? Diet and food preferences: check if applicable. Add a participant ? Name(Required)
First name
Last name
Does this participant have any allergies or intolerances?(Required) If yes, please specify:(Required)
Is an Epipen needed? Diet and food preferences: check if applicable. Add a participant ? Name(Required)
First name
Last name
Does this participant have any allergies or intolerances?(Required) If yes, please specify:(Required)
Is an Epipen needed? Diet and food preferences: check if applicable. Add a participant ? Name(Required)
First name
Last name
Does this participant have any allergies or intolerances?(Required) If yes, please specify:(Required)
Is an Epipen needed? Diet and food preferences: check if applicable. Add a participant ? Name(Required)
First name
Last name
Does this participant have any allergies or intolerances?(Required) If yes, please specify:(Required)
Is an Epipen needed? Diet and food preferences: check if applicable. Add a participant ? Name(Required)
First name
Last name
Does this participant have any allergies or intolerances?(Required) If yes, please specify:(Required)
Is an Epipen needed? Diet and food preferences: check if applicable. General health status(Required) I understand that it is essential to notify Leucan of any infectious manifestations that occur within 2 weeks of the activity (fever, flu-like symptoms, gastrointestinal symptoms, cold sores, skin rashes etc.).
Alcohol(Required) I understand that this activity will be alcohol free, according to Leucan's policy.
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 I agree to respect all instructions and guidelines of the activity organized by Leucan.
Consent 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.
I, the undersigned, (name of the participant), accept the terms and conditions of this activity.
Prénom
Nom
Consent for another participant 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 I agree to respect all instructions and guidelines of the activity organized by Leucan.
Consent 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.
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 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.
Consentement I agree to respect all instructions and guidelines of the activity organized by Leucan.
Consent 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.
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 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 I agree to respect all instructions and guidelines of the activity organized by Leucan.
Consent 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.
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 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 I agree to respect all instructions and guidelines of the activity organized by Leucan.
Consent 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.
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 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 I agree to respect all instructions and guidelines of the activity organized by Leucan.
Consent 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.
I, the undersigned, (name of the participant), accept the terms and conditions of this activity.
First name
Last name
Consent form for children under 14 years old Name of the child
First name
Last name
Add another participant under 14 years old Name of the child
First name
Last name
Add another participant under 14 years old Name of the child
First name
Last name
Add another participant under 14 years old Name of the child
First name
Last name
Add another participant under 14 years old Name of the child
First name
Last name
Add another participant under 14 years old Name of the child
First name
Last name
Add another participant under 14 years old Name of the child
First name
Last name
Consent I authorize that photos and videos taken of my child during the activity be used to represent Leucan's mission. I authorize that my child's 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 I agree to respect all instructions and guidelines of the activity organized by Leucan.
Consent I acknowledge that my child's participation in the activity may involve risks, and I hereby assume and freely accept all risks arising from their participation in this activity. I acknowledge and accept that Leucan declines all responsibility for the risks that my child's participation in the activity may entail and that Leucan cannot be held responsible for any damages of any kind (physical, moral or material) that my child may suffer in connection with their 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 my child as a participant or to my child's property that may arise or occur in connection with their participation in this activity, and I waive all rights with respect to the foregoing.
I, the undersigned, (name of the parent/legal guardian), authorizes the children mentionned above to participate in this activity and accept the terms and conditions of this activity.
First name
Last name
