Waiver Form - Lakeland College printable pdf download

GREAT TOBOGGAN RIDE LIABILITY RELEASE

Personal information on this form is being collected under Section 32(c) of the Freedom of Information and Protection of Privacy Act. It is required for

liability purposes and for potential medical attention. If you have any questions about the collection or use of this information, please contact the FOIP

Coordinator.

This is a release of liability, waiver of claims, assumption of risk and indemnity agreement. By signing this document, you will waive

certain legal rights, including the right to commence legal proceedings.

PLEASE READ CAREFULLY

PERSONAL INFORMATION (please print)

_______________________

_____________________________

_______________________________________

Last Name

Middle Name

First Name

_________________________________________________________

_______________________________________

Current Home Address (street/avenue/box number)

City/Town

____________________

_________________________

___________________

_________________________

Province

Postal Code

Current Phone Number

Date of Birth

(dd/mm/yyyy)

Are you a registered student at Lakeland College?

Yes

If yes, what program are you enrolled in? ________________________________________________________________________

TO: Lakeland College and Lakeland College Conference Services, their respective officers, employees, servants, agents and

independent contractors (hereinafter collectively called “Lakeland”).

I am 18 years of age, or older, do not suffer from any disability or impairment, either physical or mental, and wish to

participate in the Great Toboggan Ride. I make this statement and the other statements and agreements herein so that

Lakeland can rely upon them in deciding whether I may participate in the Great Toboggan Ride.

ASSUMPTION OF RISKS:

To induce Lakeland to permit me to participate in the Great Toboggan Ride, I represent and warrant to Lakeland and do

hereby acknowledge and irrevocably agree that:

a) the Great Toboggan Ride is a high risk sporting event and I will participate solely and absolutely at my own risk, only,

and in full knowledge of the inherent risks, dangers, hazards and conditions involved in this event; and,

b) there is a risk of the occurrence of negligence causing damage or injury, including but not limited to:

i) negligence on the part of Lakeland;

ii) negligence and damages resulting from the use or supply of equipment provided or supplied by Lakeland;

iii) negligence causing damages resulting from the actions of other participants or riders and other individuals, and any

representatives, officers, employees, servants, agents, contractors or sub-contractors of Lakeland.

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Waiver Form - Lakeland College

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