ࡱ> <>;y bjbj 0.{{|5@@8,K (&<RRRAAA$s"%%\AAAAARR sssAjRRsAssV@FRgHj  0K T%^%F%FpAAsAAAAAsAAAK AAAA%AAAAAAAAA@ `: ACTIVITY WAIVER - 2014 鶹ý Release of Liability, Waiver of Claims, Assumption of Risks and Indemnity Agreement WARNING: By signing this document you will waive certain legal rights, including the right to sue. PLEASE READ CAREFULLY! TO: 鶹ý NAME OF PARTICIPANT: __________________________________________________________ ADDRESS OF PARTICIPANT: ______________________________________________________ NAME OF INTERNATIONAL PRACTICUM: ________________________________________ LOCATION OF TRIP: ________________________________________________________________ (Referred to as this location throughout this Agreement) (Hereinafter referred to as this trip) throughout this document.) PREAMBLE This trip is an exceptional educational/working opportunity, but it is not without certain risks, dangers, hazards and liabilities to all participants. These include, but are not limited to, personal injury, death property damage, expense and other loss, delay or inconvenience, and this trips cancellation or curtailment. All persons taking part in this trip are required to accept these and other risks as a condition of their participation in this program. The Statement of Risks set forth below is intended to enable participants to better understand and accept the various risks involved in this trip. ASSUMPTION OF RISK I am aware that there are inherent risks, dangers, and hazards to which I may be exposed while participating on this trip to this Location, including, but not limited to the following: Theft, vandalism or loss of personal property; Motor vehicle or traffic accidents and a poor road and transportation system; Diseases not common in Canada; Exposure to wildlife; Different environmental and weather conditions than those in Canada; The laws of this Location may be significantly different than those in Canada; The medical facilities in this Location may well be of a lower standard than what might be expected in Canada; A significantly higher crime rate than Winnipeg or Canada and criminal activity may be a significant problem; Hazards resulting from political unrest, military and/or terrorist activity, previous or present; and Cancellation of this trip or curtailment or cancellation of individual activities due to weather, flooding, illness, political disturbances, terrorism, motor vehicle accidents, transportation problems, failure to perform on the part of the travel agents, travel guides or airline companies, problems relating to customs, immigration or visa requirements, or other circumstances either within or beyond the control of the University of Winnipeg. I am aware that there are further risks mentioned in the most current Canada Department of Foreign Affairs and International Trade Travel Report which I am required to read as a condition of my participation in this trip. I freely accept and fully assume all such risks, dangers and hazards and the possibility of personal injury, death, property damage or loss, resulting therefrom. RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT In consideration of the University of Winnipeg allowing my participation in this trip I agree as follows: TO WAIVE ANY AND ALL CLAIMS that I have in the future against the University of Winnipeg and its Board of Governors, Members, Officers, Employees, Students, Agents, Volunteers and independent contractors (all of whom are hereinafter collectively referred to as the Releasees). TO RELEASE THE RELEASEES from any and all liability for any loss, damage injury or expense that I may suffer, or that my next of kin may suffer as a result of my participation in this trip due to any cause whatsoever INCLUDING NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT, RSA 1980 C.0-3 as amended on the part of the Releasees; _________ Initial here that you have read Paragraph 2. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to the property of, or personal injury to, any third party, resulting from my participation in this trip. I understand that it is my responsibility to learn as much as possible about the risks of this trip and to weigh those risks against the advantages and to decide whether or not to participate. This Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives in the event of my death or incapacity. __________ Initial here that you have read Paragraph 5. In entering into this Agreement, I am not relying upon any oral or written representations or statements made by the Releasees other than what is set forth in this Agreement. I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I MAY OR MY HEIRS, NEXT OF KIND, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES. Signed this _______ day of ____________________, 20___. _____________________________ ___________________________________ Signature of PARTICIPANT Signature of WITNESS _____________________________ Signature of Parent or Guardian If Participant is under 18 years ______________________________ Please print Parent/Guardian name clearly This agreement must be completed in full, signed, dated, witnessed and Paragraph 2 and Paragraph 5 must be initialed before participant may participate in the activity. Appendix: Your Safety Just as you take precautions to keep yourself safe in your daily business in Winnipeg, you will also need to be aware of your safety in this foreign country. The government of Canada provides information about safety precautions for travelers traveling outside Canada. 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