1738 Consent For Medical Treatment In Canada YL1738

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CONSENT FORM FOR MEDICAL
TREATMENT IN CANADA

GOVERNING LAW
I hereby agree that the relationship and the resolution of any and all disputes arising there from
between myself and the Malibu Club physicians relating to medical treatment received during
the week of _________________________ shall be governed by and construed in accordance
with the laws of the Province of British Columbia. To obtain a copy of Young Life’s Notice of
Privacy Practices, log on to www.younglife.org or call (719) 381-1953.
HTU

UTH

JURISDICTION
I hereby acknowledge that any complaint, demand, claim or cause of action, whether based on
alleged breach of contract or alleged negligence arising out of any medical treatment received
from the Malibu Club physicians, would be governed by the jurisdiction of the Province of
British Columbia.
By signing this statement, I hereby understand and agree that if I commence any such legal
proceedings, they will be limited to the exclusive jurisdiction in the Courts of the Province of
British Columbia.

__________________________________
Name

__________________________________
Signature
Date

All minors visiting Malibu Club must have this form signed by their parent/guardian prior
to leaving for camp.
YOUNG LIFE SHALL NOT BE HELD LIABLE AT ANY TIME FOR LOST OR STOLEN LUGGAGE OR
PERSONAL ITEMS.

___________________________________
Parent’s Signature
Date
Required for minors
U

U

___________________________________
Parent’s Printed Name

____________________________________
Witness Signature (Notary not required) Date
Required for minors
U

U

____________________________________
Witness’ Printed Name

YL-1738 11/09 Printed in U.S.A.
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