PEMBROKE CAMPUS RECREATION CONSENT, RELEASE, WAIVER & INDEMNITY Please note: An AC Card is required for access.Member Type:(Required) Algonquin College Student Algonquin Students’ Association Employee Algonquin College Employee Community/Guest/Other Due to COVID-19 and the ongoing restrictions to campus visitors, use of the ARC is only for current Algonquin College students and staff. When restrictions are lifted, the ARC may open to the community.Choose one of the following:(Required) I am 18 years old or over. I am under 18 years old. Please Initial(Required)Informed Consent: I, the individual signing in this consent, for myself or a minor for whom I am signing this consent as parent or guardian (hereinafter referred to as the “Participant”), declare that the Participant intends to use or participate in some or all of the facilities, equipment, events, programs and services from time to time offered or made available (collectively referred in this document as “activities”) by The Students’ Association of the Algonquin College of Applied Arts and Technology Corporation (the “SA”), including without limitation those at the Students’ Association Pembroke Campus Facilities located at 1 College Way, Pembroke, ON, K8A 0C8 (the “SAPCF”). I understand that every individual (including me) has a different capacity for participating in such activities. I am aware that all activities are educational, recreational or self-directed in nature. I acknowledge that some activities or areas may be unsupervised, including among others, the locker and shower areas at the SAPCF. I assume full responsibility during and after any participation by Participant in activities and use of the SAPCF, and for the Participant’s choices to use or apply at Participant’s own risk any portion of the information or instruction received from or on behalf of the SA or its personnel. I hereby declare that the Participant is physically able to participate in any activities in which he/she/they choose to participate, including without limitation any in or at the SAPCF. I understand that part of the risk involved in the Participant undertaking any of the activities is relative to the state of fitness or health (physical, mental or emotional) and to the awareness, care and skill with which the Participant conducts himself/herself/themselves in any of the activities. In addition, I understand use of the SAPCF and participation in any of the activities offered by the SAPCF is entirely voluntary and the Participant is free to withdraw from, reduce or modify involvement in any of the activities and should do so on recognition of any signs of physical discomfort or illness (which may include, among other things, transient light headedness, fainting, chest discomfort, leg cramps, nausea, etc.). I further understand that personal injury or death is among the possible risks involved in participating in the activities or use of the SAPCF. These possible risks may include, among other things, heart attack or stroke, aggravation of any existing or past injury, discomfort or problem with any other injury, discomfort or physical problem or injury associated with physical activity. By providing my initials below at the end of this paragraph, I confirm I have read and understood the above possible risks associated with the Participant engaging in any of the activities and use of the SAPCF and I consent to the above, including without limitation, all the above-noted risks.Please Initial:(Required)Release of Liability, Waiver of Claims, and Indemnity: I, the individual signing in this release for myself and/or any minor for whom I am signing this release as parent or guardian as the Participant, and our respective heirs, executors, administrators and assigns, release The Students’ Association of the Algonquin College of Applied Arts and Technology Corporation (the “SA”) and the Algonquin College of Applied Arts Technology, and their respective contractors, servants, agents, officers, directors, governors, academic and administrative and other employees and personnel, coaches and instructors and trainers (hereinafter collectively referred to as the “Releasees”) from any claims, demands, damages, actions or causes of action arising out of or in consequence of any loss, injury or damage to the Participant’s person or property incurred or arising from the activities, including any in or on the grounds of the SAPCF, whether incurred by me or any person for whom I am signing as a parent or guardian, and without limiting the generality of the foregoing, while participating in activities offered by the SA in, from or at the SAPCF and whether in or on the grounds of the SAPCF or incurred at any other location if offered remotely, notwithstanding that any such loss, injury or damage may have arisen by reason of my negligence or the negligence of the Participant or any of the Releasees, breach of contract, or breach of any statutory or other duty of care owing under occupiers liability legislation or otherwise. I covenant not to make or bring any such claim against any of the Releasees. I will defend, indemnify and hold harmless all releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable legal fees, in connection with any third-party claim, suit, action, or proceeding arising out of or resulting from any of the activities. Please Initial(Required)Consent to Collection and Use of Personal Information and Electronic Communications: I, the individual signing in this release for myself and/or any minor for whom I am signing this release as parent or guardian as the Participant, and our respective heirs, executors, administrators and assigns, by providing my initials below at the end of this paragraph, hereby consent to The Students’ Association of the Algonquin College of Applied Arts and Technology Corporation (the “SA”): collecting, retaining and using the personal information of the Participant, and the Parent/Guardian (if applicable), and sending me and the Participant electronic messages, solely for the purposes of: communicating about or administering enrollment or participation of the Participant in activities from time to time offered by the SA, including without limitation activities at the SAPCF, contacting an emergency contact(s), if provided by or for the Participant, in the case of medical or other emergency relating to or involving the Participant (provided, for greater certainty, the SA is not under any obligation to do so), and general information and news about the SA or activities offered by the SA from time to time. I acknowledge that I, and the minor Participant for whom I am signing (if applicable) consent to receive electronically a copy of this form as signed by me. By checking the applicable box below, I am indicating consent to otherwise receive electronic messages from the SA, and may withdraw this consent at any time by contacting a member of the SA staff in person or by telephone at (613) 727-4723 x 7294 or by unsubscribing as indicated at the bottom of electronic messages from the SA. I understand, however, that if the Participant is a member of or enrolled in or using activities offered by the SA, unsubscribing may result in the loss of privileges as a member and/or enrollment in or use of the activities if, in the sole judgement of the SA, such withdrawal of consent to electronic messages hinders or interferes with either of the first two purposes set out above. To learn about the SA’s commitment to privacy and personal information handling practices, a copy of the SA’s Privacy Policy is available at www.algonquinsa.com/privacy-policy. Choose one of the following:(Required) I consent to receiving electronic messages I do NOT consent to receiving electronic messages Please Initial:(Required)Parent/Guardian Acknowledgment (if member is under 18 years old) If I am providing this Consent, Release, Waiver & Indemnity on behalf of a minor, I certify that I have the authority to sign and make decisions on behalf of the minor regarding the matters of this Consent, Release, Waiver & Indemnity. I also consent to being contacted at the information below in the event of an incident relating to or involving the Participant; I acknowledge, however, that the Releasees are not under any express or implied obligation to contact me.Please Initial:(Required) If any term or provision of this Consent, Release, Waiver & Indemnity is held to be invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement shall be governed by and construed in accordance with the laws of the Province Ontario and the federal laws of Canada applicable therein. Any claim or cause of action arising under this Agreement may be brought only in the courts of the Province of Ontario, and I hereby consent to the exclusive jurisdiction of such courts. I declare that I have read, understood and agree to the above and to this Consent, Release, Waiver & Indemnity in its entirety. Member First Name:(Required) Member Last Name:(Required) Student Email:(Required) Must be your @algonquinlive.com emailStudent Number:(Required) Staff Email:(Required) Must be your @algonquincollege.com emailParent/Guardian Name:(Required)(if member is under 18 years old) Parent/Guardian Email:(Required)(if member is under 18 years old) Emergency Contact Name:(Required) Emergency Contact Phone Number:(Required)Member Signature:(Required)Parent/Guardian Signature:(Required)(to be signed by parent/guardian if member is under 18 years old)CAPTCHA Δ
