Algonquin Students' Association | Release of Liability, Waiver of Claims, Assumption of Risks, and Indemnity Agreement for Off-campus Activity - Under 18 years old

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Warning: Please Read Carefully!

By signing this document, you hereby acknowledge, as a condition of the Participant for whom you are signing being allowed to take part 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 the Participant is being exposed to the risks identified below, and that you accept important legal obligations and waive certain legal rights, including the right to sue.

Parent/Guardian Information

Choose one of the following:*

I am signing on behalf of the Participant who is under 18 years old.

Parent/Guardian Name:*

First Last

Parent/Guardian Email:*

Telephone Number:*

Participant Information

Participant Name:*

First Last

Participant Student ID Number:*

Participant Student Email*

Ex. abc@algonquinlive.com

Participant Date of Birth:*

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

Disclaimer

Parent/Guardian Signature:*

Assumption of Risks and Responsibilities

Parent/Guardian Signature:*

Release of Liability, Waiver of Claims, and Indemnity Agreement

Consent*

In consideration of the minor child named as the Participant above being permitted to participate in the Trip, I agree to the following:

To assume and accept all risks arising out of, associated with, or related to the Participant’s 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 (including without limitation, loss or theft of my personal property) that the Participant may suffer as a result of 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 the Participant’s 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.

I understand.*

Parent/Guardian Signature:*

Acknowledgement

Parent/Guardian Signature:*

Witness Information:

Name of Witness:*

First Last

Signature of Witness:*

Telephone Number of Witness:*

Parent/Guardian Signature:*

Participant Signature:*

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