Algonquin Students' Association | Release of Liability, Waiver of Claims, Assumption of Risks, and Indemnity Agreement for Off-campus Activity

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Warning: Please Read Carefully!

By signing this document, you hereby acknowledge, as a condition of you being allowed to be a Participant on the Trip set out below that you understand the risks associated with this activity, that you are aware that by participating in this activity you are being exposed to the risks identified below, and that you accept important legal obligations and waive certain legal rights, including the right to sue.

Participant Information

Choose one of the following:*

The participant is 18 years old or older.

The participant is under 18 years old.

If the participant is under 18 years old, please contact the event organizer directly.

Thank you!

Campus*

Ottawa

Pembroke

Name:*

First Last

Student ID Number:*

Student Email*

Ex. abc@algonquinlive.com

Date of Birth:*

Telephone Number:*

Emergency Contact

Emergency Contact:*

First Last

Relationship to Participant:*

Telephone Number*

Off-campus Activity Information

Description of Off-campus Activity (referred to herein as the “Trip”):*

Is it a multi-day Trip?*

Yes

Date*

Date (From):*

Date (To):*

Destination:*

Street Address City / Town Province / State Country

Pembroke Off-campus Activity Information

Description of Off-campus Activity (referred to herein as the “Trip”):*

Is it a multi-day Trip?*

Yes

Date*

Date (From):*

Date (To):*

Destination:*

Street Address City / Town Province / State Country

Disclaimer

The Algonquin Students’ Association, their officers, directors, employees, volunteers, members, and their respective representatives (hereafter referred to collectively as the “SA”) are not responsible for any injury, loss, or damage to personal property arising out of any cause or nature whatsoever sustained by you or any other person in any capacity during the Trip. The SA accepts no responsibility and assumes no liability, whether with respect to any academic, vocational, medical, or financial or other advice or assistance of any kind whatsoever, received by you or any person before, during or after the Trip.

Participant Signature:*

Assumption of Risks and Responsibilities

I acknowledge that I am aware that possible risks, dangers, and hazards are associated with and/or which might result from participation in the Trip and any related activities. These risks include but are not limited to: severe or fatal bodily injury; risks associated with travel to and from the location to be visited; and the possibility of bodily injury, including muscular injuries, soft tissue injuries, broken bones, bruises, scrapes, cuts, sprains, dislocations, head injuries, facial injuries, eye injuries, and/or dental injuries. Without limiting the foregoing, I also acknowledge that I am aware that not wearing a helmet while skiing or snowboarding will severely increase the risk of a head injury. I will not consume alcohol or any other substance that could impair senses or judgement prior to or while skiing or snowboarding.

I consent to receive first aid, medical treatment and evacuation (as applicable), if provided or arranged by SA, in the event of an accident, injury, or illness while on the Trip. I acknowledge the SA is under no obligation to provide or arrange any such first aid or medical treatment and that I may have to pay the costs of first aid or medical treatment or care, and/or evacuation, if provided to me.

I acknowledge that the SA has no control over and assumes no responsibility for any independent contractor providing any services for or other activities at or within or as part of the Trip.

Participant Signature:*

Release of Liability, Waiver of Claims, and Indemnity Agreement

In consideration of the SA allowing me to participate in the Trip, I agree to the following:

To assume and accept all risks arising out of, associated with, or related to my participation in the Trip and all related activities, even though such risks may have been caused by the acts or omissions of the SA (including without limitation, negligence, gross negligence, breach of contract, breach of any statutory or other duty of care, and/or breach of standard of care);
To release the SA from any and all liability from any loss, damage, injury, or expense of any kind damage (including without limitation, loss or theft of my personal property) that I may suffer as a result of my participation in the Trip and any related activities due to any cause whatsoever; and
To hold harmless and indemnify the SA from any and all claims, demands, actions, and costs of any kind whatsoever which might arise out of my participation in the Trip and all related activities and any matters or litigation arising therefrom (including without limitation, any litigation in which the validity or enforceability of this agreement is contested); and from any and all liability for any damage to the personal property of, or personal injury to, any third party resulting from my participation in the Trip and any related activities.

This Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, and representatives in the event of my death or incapacity. In entering into this Agreement, I am not relying upon any oral or written representations or statements made by the SA.

This agreement and any rights, duties, and obligations as between the parties to this agreement shall be governed by and interpreted solely in accordance with the laws of the Province of Ontario and no other jurisdiction, regardless of the destination of the Trip or any jurisdiction through which the Trip may transit. Any litigation relating to this agreement or the Trip or any activities relating thereto shall be brought solely within the Province of Ontario and shall be within the exclusive jurisdiction of the Courts of the Province of Ontario.

I agree that the purpose of this agreement is that it shall be an enforceable release of liability and indemnity as broad and inclusive as is permitted by Ontario law. If any portion or provision of this agreement is found to be invalid or unenforceable, I agree the remainder will continue in full force and effect and that any invalid provision will be modified or partially enforced to the maximum extent permitted by law to carry out the purpose of the agreement.

Participant Signature:*

Acknowledgement

I acknowledge that I have read and understood this Agreement, and I am aware that by signing this Agreement I am waiving certain legal rights, including without limitation the right to bring legal proceedings against any of the persons or entities named herein as the SA, to which I or my heirs, next of kin, executors, administrators, and representatives may otherwise have been entitled.

Signature Date*

Participant Signature:*

Name of Witness:*

First Last

Signature of Witness:*

Telephone Number of Witness:*

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