Release of Liability, Waiver of Claims, Consent & Assumption of Risk
SIGNING THIS DOCUMENT MEANS YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE
Full name: ___________________________________________________________________________ (“Student”)Nova Scotia health card number: _________________________________________ Expiry date: _______/_______ Date of birth: _______________________________(y/m/d)
Allergies, intolerances and dietary restrictions: ________________________________________________________________ ________________________________________________________________________________________________________
Any medical conditions that may affect the Students ability to participate: _________________________________________ ________________________________________________________________________________________________________
If the Student requires any special accommodations, please specify ______________________________________________ ________________________________________________________________________________________________________
Emergency Contact: ______________________________________ Phone number: _________________________________
The Skills Canada Nova Scotia (“SCNS”) Skilled Futures program (the “Program”) is an exceptional educational opportunity,but it does involve certain risks, dangers, hazards and liabilities for all participants. These include personal injury, death, illness, property damage, expense and other loss. All persons taking part in the Program are required to accept any liabilityor risk of injury, loss, damage or expense sustained as a result of any person’s participation in the Program as his or her own.
Each participant in the Program (and their parent/guardian if applicable) is required to sign this form, which releases SCNS, and persons associated with it, from any claims which might arise from participation in the Program.
SCNS and its partners respect your privacy. We protect your personal information and adhere to all legislative requirements with respect to protecting privacy. We do not rent, sell, or trade our mailing lists. The information you provide will be used to deliver programming and to keep you informed and up-to-date on the activities of SCNS.
DISCLOSURE OF INFORMATION (Optional)
I understand and agree that information pertaining to participation in a SCNS program, including but not limited to names, occupation, and status as a student or apprentice, may be shared with or released to the media for coverage of the event. I also agree that photographs and videos taken during the Program may be used and reproduced by SCNS and its partners in media, promotional materials, and bulletins.
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DESCRIPTION AND ASSUMPTION OF RISKS
I understand and acknowledge that the Program involves the risks inherent in participation in certain activities, and participation in the Program, including travel to and from, will involve risks, dangers, hazards and liabilities, including but not limited to personal injury, death, illness, property loss or damage, expense and other loss due to all manner of causes including but not limited to, use of equipment and/or materials related to the trade and food related illness.
I freely accept and assume all risks, dangers, hazards and liabilities, including but not limited to personal injury, death, illness, property loss or damage, expense and other loss which may occur during or as a result of participation by the Student in the Program.
RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND INDEMNITY
In return for the approval of SCNS for the Student’s participation in the Program, I hereby agree to give up any and all claims that I, or the Student, have or may in the future have against SCNS, its employees, directors, officers and representatives, as a result of participation in the Program, and to release SCNS, its employees, directors, officers and representatives from any and all liability for any loss, damage, injury or expense that I, or the Student, may suffer during or as a result of participation in the Program.
I further agree to hold harmless and indemnify SCNS, its employees, directors, officers and representatives from any and all liability for any loss, damage, injury or expense that I, or the Student, or my next of kin, or anyone else may suffer as a result of participation in the Program.
I have carefully read and fully understand and agree to the terms of this Agreement.Agreed To this _____ day of _____________________, 20____
(Signature of Witness)
(Name of Witness – Printed)
(Signature of Student)
(Name of Student – Printed)
IF STUDENT IS UNDER 19 YEARS OF AGE SIGNATURE OF PARENT OR GUARDIAN IS ALSO REQUIRED
Agreed To this _____ day of _____________________, 20___
(Signature of Witness)
(Name of Witness – Printed)
(Signature of Parent/Guardian of Student)
(Name of Parent/Guardian of Student – Printed)
Teachers, please return this completed and signed form by fax or email scan to Laura King, SCNS Program Manager: (902) 428 email@example.com