Hike for Hospice Palliative Care Host Site Participation Agreement and Waiver

Required Fields show an asterisk (*)

Organization Name*
Event Coordinator Name*
First Last
Address*
Street Address Address Line 2 City Province Postal Code
Phone*
Fax
Email*
By checking the box below you are confirming your organization's intention to participate in the 2020 Hike for Hospice Palliative Care. This also confirms that your organization agrees to adhere to the terms laid out in the Hike/Host Site Participation Agreement.*
- I have read and accepted the terms of the 2020 Hike/Host Site Participation Agreement and agree to participate as a Host Site for the 2020 Hike for Hospice Palliative Care.
*
- We hereby agree to indemnify and hold the Canadian Hospice Palliative Care Association harmless from any and all liability (personal, physical and/or financial) related to the organization and operation of the Hike for Hospice awareness and fundraising event.
Date on which the organization's 2020 Hike for Hospice Palliative Care is being held*
Date Format: MM slash DD slash YYYY
*
- By checking this box you are hereby agreeing that you are electronically signing the 2020 Hike for Hospice Palliative Care Host Site Participation Agreement and Waiver
Name*
First Last
Title*
Today's Date*
Date Format: MM slash DD slash YYYY
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Name
This field is for validation purposes and should be left unchanged.