Metchosin Wilderness Camp- Waiver of Liability
1240 Yates Street, Victoria, BC, V8V 3N3
Phone: (250) 384-9133 Fax: (250) 384-9136
Participant Agreement, Release, and Acknowledgement of Risk
In consideration of the services of Boys & Girls Club Services of Greater Victoria, their directors, officers,
managers, employees, volunteers, and all other persons or entities acting in any capacity on their behalf
(hereafter collectively referred to as Boys & Girls Club Services), I hereby agree to release and discharge
Boys & Girls Club Services, on behalf of myself, my children, my parents, my heirs, assigns, personal
representative and estate as follows:
I acknowledge that adventure-based activities such as but not limited to backpacking, mountaineering,
canoeing, climbing and challenge activities entail known and unanticipated risks that could result in
serious physical or emotional injury, such as but not limited to, paralysis, death, or damage to myself, to
property, or to third parties. I understand that such risks simply cannot be eliminated without
jeopardizing the essential qualities of the activity.
I expressly agree and promise to accept and assume all of the risks existing in this activity. My
participation in this activity is voluntary, and I elect to participate with full understanding of the risks.
I certify that I have no medical or physical conditions, which could interfere with my safety in this
activity, or else I am willing to assume – and bear the costs of – all risks that may be created, directly or
indirectly, by any such condition.
I understand that care and attention will be given to the safety of all participants but that Boys & Girls
Club Services cannot be held liable for any injury or loss.
I understand that Boys & Girls Club Services reserves the right to remove a participant from the program
if the instructors deem it necessary to ensure the safety and well being of other participants.
I have had sufficient opportunity to read this entire document. By signing the below I acknowledge that
I have read and understood the above waiver of liability, and I agree to be bound by its terms.
Course Name & Dates: _______________________________________
Signature of Participant: ______________________________________
Print Name: _________________________________________________
Date: _______________________________________________________
Participant Address: ____________________________________________________
Participant Phone #: ____________________________________________________
Parents or Guardian’s Additional Indemnification
(Must be completed for participants under the age of 19)
In consideration of _____________________________________ (print minor’s name) ("Minor") being
permitted by Boys & Girls Club Services to participate in its activities and to use its equipment and
facilities, I further agree to indemnify and hold harmless Boys & Girls Club Services from any and all
Claims which are brought by, or on behalf of Minor, and which are in any way connected with such use
or participation by Minor.
Parent or Guardian’s Signature: _________________________________________________
Print Name: _________________________________________________________________
Date Signed: ________________________________________________________________
Instructor’s Name & Signature: ________________________________________________________
BOYS AND GIRLS CLUB SERVICES OF GREATER VICTORIA
Video and Photography Release Form
I, __________________________________ do hereby consent and authorize
Boys & Girls Club Services of Greater Victoria to use and reproduce any photographs
or video recordings of ________________________________ which were taken
during participation in the program.
I understand that such photos and video will be viewed by the members of the public
for the purpose of display in connection with the promotion of Boys & Girls Club
Services programs.
_____________________________ ______________________________
(Participant or Parent/Guardian Signature) (Date Signed)
______________________________ ______________________________
(Witness Signature) (Date Signed)
DIRECTIONS TO METCHOSIN WILDERNESS CAMP
From Downtown Victoria:
Take Highway Number 1 (Douglas Street) north, approximately 9 km.
Take the HWY-14 exit, EXIT 10, west toward HWY- 1A
(COLWOOD/SOOKE/PORT RENFREW)
Follow along as the road turns into “Sooke Road/Highway 14” –
approximately 5.6 km
Turn left onto Metchosin Road, travel approximately 5.8 km
Arrive at 3900 Metchosin Road on your left.
Welcome.