Parent/Guardian Consent Form

I, [Please Enter Your Name Here](Required)

First Name Last Name

hereby give consent for the below child's name to participate in the Dreams Take Flight Halifax charter and confirm that his/her health is suitable for the trip, and hereby release Air Canada and Dreams Take Flight Halifax/Canada of all responsibility in the event of an accident.

I acknowledge that Dreams Take Flight Halifax/Canada consists of a group of volunteers, giving their time freely and without remuneration of any sort.

I acknowledge that the purpose of this trip is to take my child/ward to Disney World in Orlando, Florida and the below child must meet the following criteria:

Financially the child would not have the opportunity to ever experience a visit to a theme park and has NEVER been to Disney theme park.
The child is a Canadian citizen, and has or can obtain a valid birth certificate. The child is between the ages of 7-12 years old (unless otherwise discussed) and is legally allowed to enter the United States of America.
The child is physically able to handle the long and extremely tiring day (approximately 21 hours), on their own without the aid of their own personal nurse or doctor.

This consent shall serve as sufficient consent for the entry to and from Canada and the United States of America for the purposes of Customs and Immigration laws of both countries. In the event of an emergency and it is deemed (by medical staff accompanying the flight) that medical attention is required, this consent shall serve as my consent to obtain emergency medical treatment for my child/ward at anytime during the trip while under supervision of Dreams Take Flight Halifax/Canada, without my further consent written or oral.

I hereby waive any right of action or possible claim, and agree not to pursue any action arising out of an injury to my child/ward or their effects caused by the negligence or actions of any Dreams Take Flight Halifax/Canada volunteers, agents, or anyone associated with Dreams Take Flight Halifax/Canada.

I agree to indemnify and render harmless, Dreams Take Flight Halifax/Canada, its volunteers, agents or anyone associated with Dreams Take Flight Halifax/Canada as a result of any claim or action brought against Dreams Take Flight Halifax/Canada by any third party as a result of any injury or damage caused by my child/ward.

I acknowledge that this consent is valid in any province of Canada or any state of the United States of America, and shall supersede any legislation where a conflict exists with this consent.

All allergies and medical conditions for my child/ward and their applicable treatment or medications have been disclosed on the Dreams Take Flight Halifax/Canada fact sheet or the child medical release form.

Date of Signing(Required)

Parent/Guardian Name(Required)

First Last

Parent/Guardian Signature(Required)

Witness Name(Required)

First Last

Witness Signature(Required)

Does the child's guardians live apart?(Required)

Yes

Other Guardian's Date of Signing

Other Parent's/Guardian's Name

First Last

Other Parent's/Guardian's Signature

Witness Name for other Guardian

First Last

Witness Signature for other Guardian

Child's Name(Required)

First Last

Name

This field is for validation purposes and should be left unchanged.

Parent/Guardian Consent Form

Dreams Take Flight | Halifax

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Medical Release