Close Alert Banner
Skip to Content
Back to City of Belleville
Website FeedbackContact UsSitemapCOVID-19 Updates

QSWC Logo

Contact Us
  • Activities and Schedules
    • Activity Guide
    • Calendars
    • Health and Wellness Programs
    • Older Adult (50+) Programs
    • Preschool, Children and Youth Programs
    • Aquatic Programs
  • Register for Programs
    • Accessibility
    • Activity Guide
    • Drop-in Fees and Passes
    • Easy Ways to Register
    • Recreation Fee Assistance
    • Register Online
  • Facilities and Rentals
    • Advertising Opportunities
    • Aquatic Facilities
    • Arena and Ice Rentals
    • Book a Facility
    • Facility Calendar
    • Outdoor Pool and Splash Pads
    • Rules and Policies
  • Plan Your Visit
    • Accessibility
    • Activity Schedule
    • Contact Us
    • Fees
    • Frequently asked questions
    • Hours of Operation
    • News and Updates
    • Parking
    • Rules and Policies
  • About Us
    • Advertising Opportunities
    • Contact Us
    • COVID-19 Updates
    • Employment Opportunities
    • Features and Services
    • Feedback
    • Forms
    • Green Initiatives
    • Honours and Awards
    • Hours of Operation
    • Privacy Policy
    • Sponsorships and Naming Rights
    • Sports Groups and Partners within the Centre

Default Interior

Form Builder

  • Open new window to share this page via Facebook Facebook
  • Open new window to share this page via Twitter Twitter
  • Open new window to share this page via LinkedIn LinkedIn
  • Email this page Email

  2021 Program Waiver Form

Please complete the information on the form. Please ensure you sign the waiver form. A waiver is required before participating in recreation programs.

Add Remove

STOP. This waiver is an important legal document. Read it carefully. Signing this waiver is a condition of participating in the recreation program you have signed up for (the “Activity”), which is being offered by the City of Belleville (the “City”).

I, the undersigned, understand, covenant, and agree with the City as follows:

  1. Participating in the Activity brings with it an increased risk of cuts & bruises, broken bones, concussions, permanent disability or even death which could result from slips, falls, contact with other participants, misuse of equipment or other types of accidents associated with the Activity.
  2. Participating in the Activity also brings with it an increased risk of illness from bacteria, viruses such as Covid-19, or other communicable diseases which may be contracted through touching high traffic areas and equipment, being in proximity to other Activity participants or City staff, and I understand that such infection could also result in serious illness, disability, permanent loss of function, or even death.
  3. I hereby waive, discharge, and release any and all claims that I or my child, may have against the City, its directors, officers, employees, elected officials, volunteers and representatives (the "Releasees") arising from my or my child’s participation in the Activity, including without limitation, injury arising out of those risks noted above. I covenant not to sue the Releasees directly or on behalf of my child, in regard to any loss, damage, injury or expense that I or my child may suffer arising from participating in the Activity including illness or death, due to any cause whatsoever including negligence or any duty of care owed to me or my child by the Releasees.
  4. This agreement is binding upon me, my child, my heirs, next of kin, executors, administrators, assigns and representatives in the event of my or my child’s death or incapacity. 

By signing my name below, I declare to the City that: (1) I am assuming all the risks associated with  my or my child participating in the Activity; (2) I am giving up my right and my child’s right to sue the City for any and all damages that may arise out of my or my child participating in the Activity; (3) I am my child’s parent or legal guardian (if applicable).

Clear

Notice of Collection

All information including Personal Information, collected by the CIty of Belleville is done so under the authority of the Municipal Act, 2001 and the Municipal Freedom of Information and Protection of Privacy Act, each as amended and will be used for the administration purposes of the City of Belleville's recreation programs and facilities and wellness passport program. Questions about the collection of this personal information should be directed to: City Clerk, 169 Front Street, Belleville ON K8N 2Y8, Telephone: 613-968-6481.





Get In Touch

Stay up-to-date

Subscribe to this page to get notified when this page has updated content.

Notify Me

Website

Copyright 2020
The Corporation of the City of Belleville
Recreation, Culture and Community Services
Quinte Sports and Wellness Centre

Designed by eSolutionsGroup
  • Calendars
  • Playbook
  • Privacy Policy
  • Book a Facility
  • Hours
  • Website Feedback

Contact Us

Recreation, Culture and
Community Services

265 Cannifton Road
Belleville, Ontario K8N 4V8
Phone: 613-966-4632
TTY: 613-771-9781
Email Us

Stay Connected

View our Facebook Page Facebook View our Twitter Page Twitter View our YouTube Page YouTube
Close Old Browser Notification
Browser Compatibility Notification
It appears you are trying to access this site using an outdated browser. As a result, parts of the site may not function properly for you. We recommend updating your browser to its most recent version at your earliest convenience.