Clone of Clone of DORCHESTER PROGRAMS
  •  

    REGISTRATION FORM

  • Thank you for your interest in BGC London and our Summer program hosted in partnership with Schulich, the School of Medicine and Dentistry. We’re excited to offer a variety of opportunities for children, youth, and families to learn, grow, and have fun together.

    Please complete this form to register for our upcoming program.

    📌 What you’ll find here: program details, schedules, costs, and payment options.

  • Schulich School of Medicine & Dentistry at Western University, in partnership with BGC London, is offering an enriching summer program designed for students interested in exploring careers in medicine. This program provides students with an opportunity to engage in hands-on learning experiences, attend informative workshops, and participate in interactive discussions about the various fields within medicine. Participants will gain insights into the medical curriculum, meet faculty and current students, and explore essential skills needed for a successful career in healthcare. This immersive experience not only broadens students’ knowledge of medical programs but also helps them make informed decisions about their future educational paths in the field of medicine. 

    👧 Ages: 13–18
    📍 Location: BGC London/ Western Campus
    🗓 Days & Dates: First Cohort: July 20th-21st l Second Cohort: July 22nd-23rd
    ⏰ Time: Each day: 9:00 AM-4:00 PM
    💲 Cost: $10

  •  Cancellation and Refund policy 

    **Once the program starts, no refunds will be given. Any refunds must be requested at least 24 hours before the start of the program and may be subject to a $5 administration fee.

    ✅ Please contact Heather Taylor at htaylor@bgclondon for more information

  • Participant's Information

  • Participant's Date of Birth*
     - -
  • Does the participant have any medical conditions we should be aware of?*
  • Are there any medications the participant is taking we should be aware of? (Including inhalers, insulin pumps, etc.)*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Emergency Contact Information

  • Format: (000) 000-0000.
  • How did you hear about this program?*
    • Waiver 
    • BGC LONDON (BOYS & GIRLS CLUB OF LONDON)

      RELEASE OF LIABILITY, WAIVER OF CLAIMS

      ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT.

       

      BY SIGNING THIS AGREEMENT YOU WILL WAIVE CERTAIN

      LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE

      PLEASE READ CAREFULLY!       

    • TO:    Boys & Girls Club of London and the Boys & Girls Club of London Foundation (together the “BGCL”) and their directors, officers, employees, instructors, agents, representatives, volunteers, independent contractors, subcontractors, sponsors, successors and assigns (hereinafter collectively referred to as the “Releasees”).

       

      COVID – 19   COVID-19 is a contagious disease (“Covid”). We care about you, your family, our employees and the public. We strive to obey the law and follow Covid guidelines and implement all risk mitigation measures. However there are significant health risks and high risk of transmission through physical or shared contact. COVID-19 is novel and, because it can be transmitted through physical or shared contact with another person, the risk of contraction from engaging in sport activities may be foreseeable.

       

      ASSUMPTION OF RISKS

      I am aware that the activities at the BGCL programs involve risks and dangers that may cause serious injury and even death, and loss or damage to personal property. These risks are inherent in the activities and cannot be eliminated without altering their character and value. The risks include, among others, the following: contracting Covid;  moving about the BGCL premises; negligence on the part of myself and/or other participants; negligence of the BGCL and its staff, including the improper use of equipment; the breakage and failure of equipment and structures; over exertion, together with other risks which may be encountered and NEGLIGENCE ON THE PART OF THE RELEASEES, INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE.

       

      The BGCL programs are designed for use by participants of average strength, mobility and fitness who are in good health. Several medical
      conditions, including but not limited to obesity, high blood pressure, cardiac and coronary artery disease, pulmonary problems, arthritis, tendonitis, or joint and muscular-skeletal problems may impair the safety and well being of participants as may other medical, physical, psychological or psychiatric problems. All such medical conditions may increase the risk of participating in the programs and cause the participant to be a danger to themselves or others. Participants with underlying medical, physical, psychological or psychiatric conditions must evaluate their condition and their ability before choosing to participate in the programs. All participants must inform BGCL in writing of any such medical, physical, psychological or psychiatric conditions before participating in any programs. The Releasees reserve the right to prevent any person, for medical or safety reasons, from participating in the programs at any time.

       

      I AM AWARE OF THE RISKS, DANGERS AND HAZARDS ASSOCIATED WITH MY USE OF THE BGCL PROGRAMS AND I FREELY ACCEPT AND FULLY ASSUME ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE AND LOSS RESULTING THEREFROM.

       

      RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

      In consideration of the Releasees permitting my use of the BGCL PROGRAMS and other facilities at the BGCL (hereinafter referred to as “the BGCL Facilities”), I hereby agree as follows:

       

      1. TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against the RELEASEES, and TO RELEASE THE RELEASEES from any and all liability for any loss, damage, expense or injury including death that I may suffer, or that my next of kin may suffer resulting from either my use of or my presence at or on the BGCL Facilities DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE UNDER THE OCCUPIERS LIABILITY ACT, RSO 1990, c.02  ON THE PART OF THE RELEASEES, AND ALSO INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS REFERRED TO ABOVE;

       

      1. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to property of or personal injury to any third party, resulting from my use of or presence on the BGCL facilities.

       

      I HAVE READ AND UNDERSTAND THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES.

       

      Signed {dateAnd}

    • Additional Permissions 
    • MEDIA CONSENT
      BGCL reserve the right and permission to publish, reproduce, distribute and/or otherwise use any still or moving photograph, for such purposes and with such frequency as it shall determine in its sole discretion without further compensation or consideration to me and without further authorization by me for, yet, unnamed video or photographic projects (including promotion, marketing and social media) which shall constitute the sole property of BGCL. BGCL shall be released from and against all liability resulting from its use of the photos or related to my use of the product.
    • I have read and understand the Photo Consent Release*
    • Date and Time Signed
       - -
  • Payment

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        Cohort 1 (July 20-21) - GENERAL FEE


        $10.00 CAD$10.00CAD
          
        Cohort 2 (July 22-23) - GENERAL FEE
        $10.00 CAD$10.00CAD
          

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