Part 1 of 10 10% Release of Liability, Waiver of Claims, Assumption of Risks, Indemnity Agreement, and Jurisdiction Agreement By signing this document, you will be waiving certain legal rights, including the right to sue. Please read carefully! TO: The Students’ Association of The Algonquin College of Applied Arts and Technology Corporation (referred to in this document as “SA”) AND TO: The Algonquin College of Applied Arts and Technology (referred to in this document as “Algonquin College”) This form is required to be completed and signed for you to access the indoor climbing wall operated by the SA on the college campus. If you do not understand the terms or conditions below, do not sign this document. Choose one of the following:(Required) I am the age of 18 or over. I am under 18 years old. Choose one of the following:(Required) I consent to receiving electronic messages I do NOT consent to receiving electronic messages Please Initial(Required) If Participant is a Minor If participant is a minor, a parent or guardian is required to check all boxes in the form and to sign below: In consideration of the minor child named as the participant in the form above being permitted to participate in climbing, courses and/or other activities, I accept and agree to the full contents of the above agreement. I certify that I have the authority to sign on behalf of the minor child and to make decisions for the minor child regarding participating in climbing, courses and other activities. I acknowledge all of the terms and conditions set out in the agreement and agree as provided above to release, hold harmless, indemnify and defend the Releasees from all liabilities and claims that arise in any way from any injury, death, loss or harm that occurs to the minor child during climbing, courses or other activities, or in any way relating thereto, including without limitation any claim of the minor. I understand that nothing in this agreement is intended to release claims for acts or omission that Ontario law does not permit to be excluded by agreement. Please Initial(Required)Parent/Guardian Name(Required)Relationship(Required) Definitions In this agreement, the following terms have the meanings below: “climbing” or “bouldering” refer to and include, but are not limited to, any activities taking place on or around the climbing wall. “climbing wall” means the indoor artificial climbing wall located in the facilities. “course” means all activities related to an instruction or training relating to climbing or usage of the climbing wall, including without limitation, general orientation, a belay instruction course, or camps. “facilities” means the buildings and lands on the College campus at which the climbing wall is located. “injury” means all forms of physical, mental, and emotional injury in any way related to climbing, including but not limited, to death, breaks, strains, lacerations, dislocations, amputations, trauma, anxiety, phobias, and fears. “other activities” means all activities other than climbing or a course in which you participate or that otherwise are taking place involving other persons at the Facility. Acknowledgment and Assumption of Risks: I am aware of the risks, dangers, and hazards associated with climbing and other activities, and I freely accept and fully assume all such risks, dangers, and hazards and the possibility of all manner of personal injury, death, property damage, or loss resulting therefrom, including without limitation: falling while roped or un-roped, while using the facilities, the climbing wall and impacting against the floor, mats, holds, ledges, edges, other climbers, and/or permanent or temporary fixtures. abrasion, entanglement, and other injuries resulting from activities on or near the climbing wall such as climbing, belaying, rappelling, lowering on a rope, rescue systems, and other rope techniques, and mats. resulting from falling climbers or falling objects (whether dropped by other persons using the climbing walls, or detaching from the wall, roof, and/or supporting structure, or otherwise), such as ropes, climbing hardware, modular holds and their parts, anchors, harnesses, or helmets. cuts and abrasions resulting from contact with the climbing wall, fixtures, climbing panels or mats. failure of ropes, knots, slings, harnesses, climbing equipment, anchor points, and/or any part of the climbing wall. failure of another person or belay equipment to protect against a fall. I acknowledge and accept the risks include, but are not limited to those above, and the failure to climb safely within one’s ability or within designated areas, human error, failure to predict whether facilities are safe for climbing or other activities or whether an accident may occur or to recognize a hazardous situation, and negligence of other persons including climbers, rescuers or persons providing first aid or other medical treatment.(Required)Please InitialI also acknowledge and accept negligence on the part of other users of the facilities, and Algonquin College and/or the SA and their respective directors, officers, employees, and contractors, including the failure of any of them to safeguard or protect me from risks, dangers, and hazards of climbing or other activities.(Required)Please Initial Acknowledgment of Medical Conditions, Waiver of and Consent to Medical Treatment: The SA and Algonquin College assume no responsibility for providing medical care during climbing or other activities. I consent to receive first aid and medical treatment provided or arranged by SA and/or Algonquin College staff in the event of an accident, injury, or illness while using the climbing wall or the facilities. I acknowledge I may have to pay the costs of first aid or medical treatment or care, and/or evacuation, if provided to me. Climbing and/or any course in which I am participating requires a high degree of physical and mental fitness. It is my responsibility to make the SA staff aware of any and all limitations I may have. I confirm that I have made any and all of my medical conditions known to SA staff and specifically brought their attention to any conditions that would prevent me from climbing or increase the risks, hazards, and dangers.(Required)Please Initial Acknowledgment of Increased Risks of Not Wearing a Helmet:I am aware that not wearing a helmet during climbing will severely increase my risk of injury.(Required)Please Initial Agreement to Follow Rules and Directions: I agree to follow all rules for admission to and/or use of the climbing wall facilities of which I am advised from time to time by the SA or Algonquin College, including without limitation, all directions given to me orally or in writing or by gesture by employees or contractors of the SA and the Algonquin College who are providing instruction, supervision or assistance with climbing, courses or other activities relating to the climbing wall or at the facilities. I will not consume alcohol or any other substance that could impair my senses or judgement prior to or while using the climbing wall or the facilities. I will take appropriate care with and use all protective equipment as directed. Without limiting the generality of the foregoing, When climbing, I will always wear a climbing harness for which I assume responsibility for putting on and fastening correctly. I will promptly report to SA staff at the facilities any equipment defects, unsafe situations, or accidents I will not provide formal or informal teaching or coaching of individuals or groups unless I am properly trained and certified and have written permission from the SA. I agree to follow rules and directions.(Required)Please Initial Release of Liability, Waiver of Claims, and Indemnity: In the consideration of the SA, Algonquin College, and their staff, employees, board members, and contractors allowing me to participate in climbing and other activities, I hereby agree as follows: To waive any and all claims that I have or may have in the future against the SA, Algonquin College, and their board members, employees, staff, contractors, agents, successors, and assignees (all of whom are referred to hereinafter as “releasees”) and to release the releasees from any and all liability for any loss or damage (including without limitation, loss or theft of my personal property), expense or injury including death that I may suffer or that my next of kin or guardian may as a result of my participation in climbing and other activities, due to any cause whatsoever including negligence, gross negligence, breach of contract, breach of any statutory or other duty of care, and/or breach of standard of care, on the part of the releasees, and including the failure on the part of the releasees to safeguard or protect me from the risks, dangers, and hazards of climbing and participating in other activities. To hold harmless and indemnify the releasees from any and all liability for any property damage or personal injury to any third party resulting from my participation in climbing and other activities in or at the facilities. To hold harmless and indemnify the releasees from any and all liability for any costs they may incur for medical costs, evacuation, and litigation resulting from my participation in climbing and other activities, including without limitation, that in any litigation in which the validity or enforceability of this agreement is contested that the prevailing party will pay all attorneys fees and costs of the parties seeking to uphold this agreement. That this agreement shall be binding upon my heirs, next of kin, executors, administrators, assignees, representatives, and guardians, in the event of my death or incapacity. That 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, any litigation relating to this agreement or the climbing wall or other activities at the facilities shall be brought solely within the Province of Ontario and shall be within the exclusive jurisdiction of the Courts of the Province of Ontario. Please Initial(Required) Additional General Terms and Conditions: Contractors. I acknowledge that the SA and Algonquin College has no control over and each assumes no responsibility for any independent contractor providing any services for climbing, courses, or other activities at or within the facilities. Modification or Revocation of Privileges. I acknowledge that privileges to access or use the climbing wall, courses or the facilities may be modified or revoked in whole or in part by the SA in its sole discretion, including without limitation, if I engage in any behaviours or activity deemed to be unsafe to myself or other users of the climbing wall or the facility. Use of Likeness. I acknowledge that during my use of the climbing wall or the facility, I may be photographed or videotaped. To the fullest extent allowed by law, I waive all rights of publicity or privacy or pre-approval that I have for any such likeness of me or use of my name in connection with such likeness, and I grant to the SA and Algonquin College and the respective assigns permission to copyright, use, and publish (including by electronic means) such likeness of me, whether in whole or part, in any form, without restrictions, for any purpose. Effective Time for Agreement. This agreement becomes effective upon my signature, and continues in effect and applies to each occasion on which I subsequently am admitted to or use the climbing wall or facilities for climbing, courses or other activities. Severability. 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. In entering this agreement, I confirm that am not relying on any other oral or written representations or statements made by any of the Releasees with respect to the safety of climbing or other activities other except as expressly set out in this agreement. I agree to the General Terms and Conditions(Required)Please InitialI have had sufficient opportunity to read this entire to document, have read and understood and agree to abide by the terms and conditions as set out above. I am aware that by signing this agreement I am waiving certain legal rights which I and/or my heirs, next of kin, executors, administrators, assignees, representatives, and guardians may have against the releasees.(Required)Please Initial Name(Required) First Last Email(Required) PARTICIPANT SIGNATURE(Required)PARENT/GUARDIAN SIGNATURE(Required)(to be signed by parent/guardian if member is under 18 years old)CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Δ
