If you experience any technical difficulties when using this form or if you have registration
questions, please contact the Canadian Paediatric Review Program at:
Section A - Delegate Information
Section B - Delegate Registration
Registration fees include all programming from Monday, January 10 to January 14, 2022.
Session video recordings will be made available to attendees after the program for a limited time. All amounts
are in Canadian dollars.
No session selection is required. There is no option to purchase one-day passes.
Please select a registration type.
Section C - Payment Information
Please verify all the information is correct. By submitting your payment, your credit card statement
will show this transaction as Canadian Paediatric Review Program.
Cancellation Policy - All cancellations must be received in writing no later than
December 20, 2021 for a full refund, less an administrative fee of $100.00. No refunds will be issued
after this date. We will not be able to issue refunds due to technical issues experienced due to a poor
internet connection or your equipment not meeting the technical requirements.
Section D - Participant Consent & Release Agreement
(Please scroll to the end and click on I AGREE checkbox after reading.)
CONSENT TO BE VIDEO RECORDED, AUDIO RECORDED, PHOTOGRAPHED, RECORDED AND/OR TO HAVE PUBLIC DISCLOSURE OF
AND WAIVER OF CONFIDENTIALITY FOR MEDIA PURPOSES.
I hereby give my permission and express written consent to McMaster’s Children Hospital (referred to
herein as “MCH”)
at or in respect of the Canadian Paediatric Review Program (referred to herein as “CPRP”) to digitally
video record, videotape,
digitally audio record and/or photograph me while I am attending and participating in the MCH CPRP.
I further consent to MCH
and its agents and assigns exhibiting, showing, re-producing, publishing, displaying, transmitting and other
uses of all such video
and audio recordings and photographic images in any media whatsoever in Canada or elsewhere, including
presentations made for medical,
scientific, educational and related marketing purposes.
I further acknowledge, confirm and agree that I shall have no right to inspect or approve any video and audio
and/or photograph(s) of me prior to it or their use by MCH or its agents and assigns in any manner
and confirm and agree
that I will receive no financial compensation arising from such use, including, without limitation, my
providing services as a model.
I hereby fully and finally release MCH and its agents and assigns from any and all liability directly
arising out of the video and audio recordings and photographic images made and/or taken of me including,
how such recordings and images are used by MCH and its agents and assigns, the final form of such
recordings and photographs
and the timing, method and basis of it or their publication and distribution.
I acknowledge that MCH and its agents and assigns shall have the right to cancel or convert to a
virtual event any event
offered or organized by MCH or its agents and assigns for which I may register to attend up to and
including the day immediately
prior to the scheduled commencement date of such event by email notification to me at the last email address
I have electronically
delivered to MCH and its agents and assigns. I hereby further release MCH and its agents and assigns
from any and all claims
relating directly or indirectly to such cancellation that I or my heirs, executors and administrators may
have and hereby confirm and
agree that MCH and its agents and assigns shall at no time be liable to me or my heirs, executors and
administrators for any
direct or consequential losses, damages, expenses or costs which I may suffer or incur as a result of a
cancellation, including, without
limitation, unnecessary travel expenses and loss of income.
WAIVER OF LIABILITY AND ASSUMPTION OF RISK ACKNOWLEDGEMENT
In consideration of MCH and its agents and assigns permitting me to participate in any capacity
whatsoever in the MCH CPRP
(including but not limited to participation as an attendee or speaker), I hereby agree to the following
- I expressly warrant and represent that by attending the MCH program I am knowingly, freely and
all risk while participating in and or attending the MCH, in any manner whatsoever, regardless of
how, where or when I may
incur or sustain any injury, damage or loss, and whether or not resulting from the negligence of
MCH and its agents and assigns
- None of MCH or its directors, officers, employees, agents or assigns (the “Releasees”) shall be
liable nor held
responsible in law by me, or my heirs, executors, assigns and any legal or personal representatives for
any physical bodily
injury (including, without limitation, loss of life or limb and contracting any communicable disease or
virus), damage or other
loss (including but not limited to economic loss) incurred by me, however sustained or incurred at any
time during my participation
or attendance at the MCH program, including my travel time to and from the MCH program.
- I hereby irrevocably release and hold the Releasees harmless in respect of any and all liability for and
in respect of my
physical injuries (including, without limitation, loss of life or limb, and contracting any communicable
disease or virus)
and/or economic loss derived from my participation and involvement, in any manner, in the MCH
- Once I have agreed to this Participant Consent and Release Agreement, it will constitute a full answer
in favour of the Releasees in relation to any claim that I may advance against same for any physical
without limitation, loss of life or limb, and contracting any communicable disease or virus), damage or
loss sustained by
me while participating in or attending the MCH program.
- I understand that it is a condition of my participation in the MCH program that I must agree to
the terms of
this Participant Consent & Release Agreement and that I am under no requirement or compulsion to
participate or attend the MCH
program and I am free to decline participation if these terms are not acceptable to me.
- While attending the MCH program I agree to abide by all rules posted or otherwise provided to me,
as all applicable federal, provincial and municipal laws and regulations.
- I agree that regardless of actual causation, I am solely responsible for my safety while participating
the MCH program.
- I understand that this is an exam preparation course and that MCH is not liable for my individual
and/or failure of any professional exam as a result of participating in this program.
- I shall not disclose, share, distribute or reproduce any course material or any provided passwords I
receive from the
MCH to any third party and acknowledge and agree that any breach whatsoever will result in no
longer having access
to all materials provided.
I have read the foregoing Participant Consent & Release Agreement and confirm and agree that I fully
understand its contents.
I hereby warrant that I am of legal age and am competent to contract. I hereby provide and deliver both my
express and informed
consent as stated above and my agreement with the terms as outlined above by clicking on the I AGREE
button/box as presented on this
website and confirm that this Participant Consent & Release Agreement when given in this manner shall be
forever binding upon me.