Nourishing Communities Form

Nourishing Communities

* Please complete the following questionnaire. This information will be used for the organization’s data collection

purpose only and will not be shared to any other party.

Nourishing Communities Extension 2021-22

> Additional Information 

I acknowledge that I have been told about the use of foods and ingredients in the Nourishing Communi-ties recipes that may contain allergen’s to an individual. It is up to me personally to decide whether these foods are safe for myself and family to consume and do not hold MIAG Centre for Diverse Women & Families and the Nourishing Communities program responsible for any illness or death as a result. I agree to release and waive all claims and hereby indemnify and hold harmless both MIAG Centre for Diverse Women and Families and the United Way Greater Toronto (UWGT) along with their elected officials, officers, employees, representatives, any affiliated companies, volunteers and other partici-pants should illness, digestive issues, gastro intestinal discomfort/distress result from my attendance in the Nourishing Communities Program

 

I have read and understood the waiver


"I agree to release and waive all claims and hereby indemnify and hold harmless both MIAG Centre for Diverse Women and Families and their funders, officials, officers, employees, representatives, any affiliated agencies, volunteers and others participants for any and all liability or personal injury resulting to me or to any of person for whom I am in law respon-sible, from or connected with participation in any activity contemplated by this Registra-tion. I hereby further agree that the MIAG Centre for Diverse Women & Families and the Insured Persons shall not be liable, either directly or indirectly, for any claims, or any dam-ages, costs and expenses respecting any act done in good faith, including but not limited to personal injury, death, property damage or loss resulting from or connected with participa-tion in any activity contemplated by this Registration.”


I have read and understood the Waiver of Liability


"I give permission to MIAG Centre for Diverse Women & Families to photograph/video me and use such photograph(s)/video(s) in all forms of media, for any and all promotional and reporting purposes. This includes sharing these photograph(s)/video(s) with funder organizations (such as United Way Greater Toronto and General Mills).  I further consent to the use of my name in connection with the photograph(s)/video(s) if needed. I understand and agree that I will not receive any payment for my time or expenses or any royalty for the publication of the photograph(s)/video(s) or the use of my name and I hereby release MIAG Centre for Diverse Women & Families as an organization, its staff, board of directors, funders, partners and volunteers from any such claims. I certify that I have read and fully understand this consent and that all questions pertaining to this consent have been answered to my satisfaction. I have read and understood the Consent to Photograph/ Video Release."


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