* Required fields

First Name*

Last Name*

Age*

Address*

City*

Province*

Postal Code*

Email*

Phone Home*

Name of School/University*

Grade/Year*

Field of Interest

Sports Activities

Community Activities

Consent Agreement:

I the undersigned understand that all sessions/activities of this program will be photographed and videotaped. I consent to ICNA Relief Canada and YLDP for using such photographs and video recordings for future presentation/advertising of YLDP.

I understand and hereby acknowledge that certain risks of injury or potential health risks may be in the participation of this program. I hereby willingly assume such risk of injury or health risks. I agree that ICNA Relief Canada and YLDP shall not be liable for any injury to my person and/or loss or damage to my personal property arising from, or in any way resulting from, my participation in this program. I therefore hereby release and forever discharge ICNA Relief Canada and YLDP from all actions, damages, claims and demands whatsoever arising by reason of participation in the program or any of its associated activities.

I declare having read and understood the above CONSENT AGREEMENT in its entirety and hereby consent to participate acknowledging all the foregoing. If I am registering a minor, I certify that I am the parent/guardian for that minor, and agree to the above on their behalf.

Please also note that online registrants MUST bring paper registration form duly signed by parents to the first YLDP session.