Fillable Release Of Liability Form printable pdf download

NATIONAL AND

INTERNATIONAL

UNIVERSITY OF OTTAWA

STUDENT MOBILITY

INTERNATIONAL OFFICE

INITIATIVE

550 CUMBERLAND - TABARET M386

OTTAWA, ON

CANADA K1N 6N5

RELEASE OF LIABILITY,

WAIVER OF CLAIMS, ASSUMPTION OF RISKS,

AUTHORIZATION AND INDEMNITY AGREEMENT

IMPORTANT NOTICE: Signing this document will affect your legal rights. Please review if carefully.

(print name), the undersigned student registered at the University of Ottawa, have chosen to take part

in the National and International Student Mobility Initiative, coordinated by the International Office at the University of Ottawa, AND I THEREFORE STATE AS

FOLLOWS:

A. Communication of information

1. I DECLARE that all the information I have provided in support of my application to participate in an international student exchange under the

International Student Mobility Initiative is accurate.

2. I AUTHORIZE the University of Ottawa to transfer my application file and all complementary information to the host institution I have chosen abroad.

3. I AUTHORIZE the University of Ottawa and the host institution abroad to divulge to relevant authorities, where applicable, any information that may

facilitate issuance of the authorizations required for my entry into, and stay within, the host country, based on the rules in effect at the host institution.

By checking the box, I AUTHORIZE the International Office to post my name, the name of the host institution, the title of the program in which I am

registered and the level of my studies at the University of Ottawa on the International Office's Web site and to include such information in the

International Office's publications. I understand that the International Office may not release my address and my telephone number without my

consent.

By checking the box, I AUTHORIZE the International Office to supply my name and uOttawa e-mail address to former, present and future University

of Ottawa participants in an international student exchange with the host institution abroad I have chosen under the International Student Mobility

initiative. I accept that my e-mail address will be included in the internal listserv of participants.

By checking this box , I AUTHORIZE the University of Ottawa to take photographs of me and to use these photographs and any photographs I take

in the host institution or the host country during my international exchange and that I provide to the International Office in its promotional material.

7. I AUTHORIZE the International Office of the University of Ottawa to receive an official transcript directly from the host institution at the end of my stay

abroad.

8. I HAVE FULLY INFORMED the person designated below as my Next of Kin concerning my participation in the International Student Mobility

Initiative in the foreign institution of higher education I have chosen abroad. He/she has agreed to act as my Next of Kin, and I AUTHORIZE the

University of Ottawa to contact the person designated below for or with information about me and to give this person the cheque for the amount of my

student mobility scholarship, if need be, unless I revoke or change the appointment by notifying the University of Ottawa in writing.

Contact information - Next of Kin

LAST NAME

GIVEN NAMES

NO. & STREET

CITY

PERMANENT

ADDRESS