Medical Information Form

I hereby authorize Jump Thru Hoops and/or an Jump Thru Hoops nurse, teacher, administrator or other employee (collectively, the “Development program”) to provide this participant with routine first aid and authorized medication.

I further understand and agree that, in the event of an emergency, the Development program may provide, administer, obtain and/or authorize medical care for the participant. I understand that in the event of a serious medical problem or emergency, the Development program will make best efforts to contact me as soon as possible. I understand and agree that this authorization shall remain in effect for the time of the program at Jump Thru Hoops. I hereby release and indemnify the Development program from any and all claims for damages arising from any injury to the participant as a result of any accident, illness, injury or for any other reason arising from participation in school activities.

I hereby acknowledge that any medical treatment will be performed in the Province of Ontario, and that the courts of the Province of Ontario shall have exclusive and preferential jurisdiction to entertain any complaint, demand, claim, proceeding or cause of action arising out of the medical treatment. I hereby agree that if I commence any such legal proceedings, I will do so only in the Province of Ontario, and hereby irrevocably submit to the exclusive and preferential jurisdiction of the courts of the Province of Ontario.

I hereby agree that the resolution of any and all disputes relating to or arising from this agreement and/or the interpretation thereof shall be governed by and construed in accordance with the laws of Ontario and the laws of Canada applicable therein.