Release And Indemnification Form For Field Trips, Exchanges Or Excursions printable pdf download

Year _______

RELEASE and INDEMNIFICATION FORM

for FIELD TRIPS, EXCHANGES or EXCURSIONS

Name:

___________________________________________________

Student Number:

___________________________________________________

Course:

___________________________________________________

Field Trip, Exchange or Excursion: _____________________________________

Date of Field Trip, Exchange or Excursion: _____________________________________

I am aware that during this field trip, exchange or excursion (the” Excursion”) in which I am participating under the

arrangements of the University of Guelph (“University”), certain risks and dangers may exist, including but not

limited to the hazards of travelling, accidents or illness in remote places without medical facilities, the forces of

nature and travel by air, train, automobile or other means. More particular risks for this Excursion may include but

are not limited to:

____________________________________________________________________________________________

I accept and fully assume all risks, dangers and hazards and the possibility of personal injury,

death, property damage or loss, resulting from my participation in this Excursion.

In consideration of approval to participate in this Excursion, I, for myself, my heirs, next of kin, executors,

administrators and assigns agree to hereby release and forever discharge the University, its officers, directors,

servants, employees and agents from any and all actions, claims and demands for damages, loss and injury,

howsoever arising which now or may hereafter be sustained by me in consequence of my participation in the above-

noted Excursion.

I also acknowledge the University does not carry accident or injury insurance for my benefit and also that there may

be certain matters for which I could be held at fault personally. In these cases, I agree to be accountable in all

respects for my own conduct and all actions, claims and demands for damages, loss and injury which may arise as a

result of my own conduct. I acknowledge and agree not to ask the University, its officers, directors, servants,

employees and agents to accept the consequences thereof and agree to indemnify the University, its officers,

directors, servants, employees and agents from any claims or demands which might be made against the University,

its officers, directors, servants, employees and agents arising out of or as a result of my own conduct.

If circumstances arise which the University, in its sole discretion considers to be an emergency, I authorize the

University to disclose any of my personal medical, health or contact information, as appropriate.

I declare that I have read and understood the above Release and Indemnification Form for Field

Trips, Exchanges or Excursions in its entirety and I hereby agree to be bound by the terms and

conditions. I am aware that by signing this agreement, I am waiving certain legal rights which I,

my heirs, next of kin, executors, administrators and assigns may have against the University, its

officers, directors, servants, employees and agents.

Date: __________________________

Signature:______________________________

Witness: _________________________________

Participant

June 2010

Release And Indemnification Form For Field Trips, Exchanges Or Excursions