SID Student Waiver for IDES 4310B - Mar 3

Name of Participant*

First Last

Carleton Id*

Email*

Address*

Street Address Address Line 2 City Province Postal Code

Phone*

Birth Date*

Emergency Contact*

First Last

Relationship to Participant*

Phone for Emergency Contact*

Disclaimer Clause*

The Governors of Carleton University AND the School of Industrial Design, their agents, officials, officers, directors, employees, volunteers, contractors, servants or representatives (hereinafter refer to as “THE RELEASEES) are not responsible for any death, injury, loss or damage of any kind suffered by any person while participating in the Field Trip to Nureva and all related activities of the Field Trip to Nureva, including injury, loss or damage which might be caused by the negligence of THE RELEASEES.

The Field Trip to Nureva includes transportation to and from Carleton University by personal private vehicles with a visit to the Nureva satellite office in Kanata, Ontario. This visit will take place in the afternoon on Friday, March 3, 2023, and the visit will last approximately one and a half hours. Each participant is responsible for their own transportation.

I agree.

Description of Risks*

In consideration of my participation in the Field Trip to Nureva program and all related activities, I acknowledge that I am aware of the possible RISKS, DANGERS AND HAZARDS associated with the Field Trip to Nureva program and all related activities including THE POSSIBLE RISK OF SEVERE OR FATAL INJURY TO MYSELF OR OTHERS. These risks include, but are not limited to:
• Risks associated with travel to and from all venues of the various components including transport by public or private motor vehicle which could include but are not limited to an accident resulting in severe physical injuries or death;
• Intoxication and/or alcohol poisoning from the alcohol I consume during the Field Trip to Nureva program and all related activities whether voluntarily or through coercion resulting in illness, injury or death;
• Food-related illness resulting from any meal arranged for me by the Field Trip to Nureva organizers;
• Muscular injuries and soft tissue injuries, broken bones, bruises, scrapes, cuts, sprains, dislocation, head, facial eye and/or dental injuries which might result from participation in the Field Trip to Nureva;
• Injuries resulting from falling or being knocked down or steep steps where a fall may cause injury or death;
• Injuries resulting from rough terrain, failure to see an obstacle, failure to negotiate a turn, etc.;
• Injuries resulting from walking on a hill, slipping and/or falling;
• Injuries resulting from malfunctioning of equipment or misuse of equipment whether owned, designed or operated by myself or the staff of the Releasees;
• Changes in weather or temperatures which may result in hypothermia, frostbite, windburn, sunburn, colds or flu;
• Death, injuries or illness resulting from failure to follow directions from those in charge of the program and all related activities;
• The risks associated with returning to my residence after participating in the program and/or related activities; and
• Other risks associated with being a spectator of or being present at a crowded, outdoor or indoor venue.

I agree to the risks.

Medical/Health and Travel Insurance*

1. I AM SOLELY RESPONSIBLE to select and purchase adequate medical/health insurance. The Releasees will provide no medical/health insurance. In the event of a medical/health problem, the Releasees accept no responsibility for any costs associated with a medical/health problem nor will they pay for any medical/health expenses that may be incurred by the participant.

2. I AM SOLELY RESPONSIBLE to select and purchase adequate travel insurance. The Releasees will provide no travel insurance. The travel insurance should provide cover against theft, personal accident, personal liability, repatriation and cancellation of tickets among other coverages. The Releasees accept no responsibility for any costs associated with these types of problems nor will they pay for any expenses that may be incurred by the participant relating to these areas.

I freely accept and assume all responsibility to provide myself with medical/health and travel insurance coverage.

Indemnification and Release of Liability*

1. TO ASSUME AND ACCEPT ALL RISKS arising out of, associated with or related to my participation in the Field Trip to Nureva program and all related activities, even though such risks may be caused by the negligence of the Releasees;

2. TO BE SOLELY RESPONSIBLE FOR ANY INJURY, LOSS OR DAMAGE which I might sustain while participating in the Field Trip to Nureva program and all related activities, even though such injury, loss or damage may have been caused by the negligence of The Releasees;

3. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES 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 Field Trip to Nureva program and all related activities;

4. TO HOLD HARMLESS, INDEMNIFY AND RELEASE THE RELEASEES, their officers, directors, agents, volunteers, employees and representatives from liability for any and all claims, demands, actions and costs which might arise out of my participation in the Field Trip to Nureva program and all related activities, even though such claims, demands, actions and costs may be been caused by the negligence of The Releasees.

In return for allowing me to voluntarily participate in the program and all related activities, I agree: to the above list.

Medical Conditions*

I agree to advise the organizers of the Event prior to the start of the activity of any existing medical conditions or injury.

Acknowledgement*

I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD THIS AGREEMENT, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, executors, administrators and representatives.

REQUIRED CAPTCHA

Waiver of Liability

WAIVER OF LIABILITY