PacificWest Adult Day Centre Registration Form

Waiver and Release of Liability

I, the undersigned, hereby acknowledge that I understand and agree to the following:

Voluntary Participation

Participation in the adult daycare program is voluntary, and I acknowledge that the services are provided to enhance the well-being of the participant.

Assumption of Risk

I understand that participation in activities may involve certain risks, including, but not limited to, falls, accidents, or injuries. I voluntarily assume full responsibility for these risks on behalf of the participant.

Release of Liability

I release, waive, discharge, and hold harmless Pacificwest Adult Day Centre INC, its staff, employees, directors, and volunteers from any and all liability, claims, or demands arising from participation in the program.

Medical Emergencies

In the event of a medical emergency, I authorize the staff to contact emergency medical services. I understand that I will be responsible for any associated costs.

Personal Belongings

I understand that Pacificwest Adult Day Centre INC is not responsible for loss, theft, or damage to personal belongings brought to the facility.

Compliance with Rules and Policies

I agree to adhere to the policies and procedures of the daycare program, including any health and safety protocols

Acknowledgment and Consent

By clicking Register, I acknowledge that I am providing this information to Pacific West Adult Day Centre Inc. for the purposes of day care registration. I confirm that I have read, understood, and voluntarily agree to the terms outlined in this waiver form. I certify that the information provided is accurate and, if applicable, that I have the legal authority to sign on behalf of the participant.