Loading...

UCM at UBC Fall Retreat Waiver

UNIVERSITY CHRISTIAN MINISTRIES

 

ACTIVITY CONSENT, WAIVER AND INDEMNITY FORM. BY SIGNING THIS LEGAL DOCUMENT YOU:

  • INDICATE THAT YOU HAVE UNDERSTOOD THE RISKS ASSOCIATED WITH THIS ACTIVITY
  • GIVE UP CERTAIN RIGHTS INCLUDING THE RIGHT TO SUE
  • AGREE TO ASSUME FINANCIAL RESPONSIBILITY FOR ANY INJURY OR DAMAGE RESULTING FROM THE PARTICIPANTS PARTICIPATION IN THE ACTIVITY
  • INDICATE THAT YOU HAVE UNDERSTOOD AND AGREE TO ALL TERMS AND CONDITIONS INCLUDED IN THIS FORM

 

PLEASE READ CAREFULLY.

 

In consideration of University Christian Ministries (UCM) allowing (the Participant) to participate in the activities offered in conjunction with the BCCM program and all associated activities, including but not limited to travel to the activities, scheduled between September 21, 2018, and September 23, 2018 (the Activities), we, the Participant and the undersigned parents/guardians of the Participants, AGREE TO THE FOLLOWING TERMS AND CONDITIONS:

 

General

1.    We approve of and give permission for the Participant to participate in the Activities as part of the UCM program.

We understand that participation in the Activities is voluntary.

 

  • Assumption of Risk
  1. We understand and acknowledge that there are risks and hazards inherent in the very nature of the Activities and as a result of the Participants participation in the Activities.  We have full knowledge of the nature and extent of these risks and hazards and acknowledge that by participating in the Activities the Participant may suffer personal injury, death, property damage, loss, delay, inconvenience and the cancellation or early termination of the Activities, which injuries and losses are inherent in all activities of this nature.
  2. We understand and are aware that the inherent risks and hazards to which the Participant may be exposed while participating in the Activities include but are not limited to the following:
  • Transportation to and from the Activities at Camp Capilano, North Vancouver, including private and/or public transportation;
  • Theft or loss of personal belongings
  • Freezing or exposure;
  • Burns;
  • Drowning;
  • Slips and falls;
  • Animal attacks;
  • Unexpected weather conditions.

We acknowledge that it is our responsibility to obtain and learn as much information as possible about the risks and hazards of the Activities and to weigh those risks against the benefits of the Activities, before consenting to the participation of the Participant in the Activities.

 

We nevertheless freely and voluntarily consent to the participation of the Participant in the Activities and agree to accept these risks and fully understand that we will be solely responsible for any loss, personal injury or damage sustained by the Participant.

 

Waiver of Liability

5.    In consideration of the Participant being allowed to participate in the Activities with its inherent risks and  
       hazards, we agree to:

  • Waive any and all claims that we or the Participant may have now or in the future against UCM and its directors, officers, employees, agents, volunteers and representatives, or any of them, in connection with the Participants participation in the Activities; and
  • Release UCM and its directors, officers, employees, agents, volunteers and representatives, or any of them, from and against any and all liability for personal injury, death, property damage or loss that we or the Participant may suffer, arising out of any cause whatsoever, including but not limited to the negligent acts or omissions of BCCM and its directors, officers, employees, agents, volunteers and representatives, or any of them, in connection with the Participants participation in the Activities.

Photographic Releases

The Participant does hereby grant and convey unto University Christian Ministries all right title, and interest in any and all photographic images and/or video and/or audio recordings made by University Christian Ministries during the Event and Travel, including but not limited to, any royalties, proceedings and/or other benefits derived from such photographic and/or video and or audio releases.

Indemnity

We agree to indemnify and hold harmless UCM and its directors, officers, employees, agents, volunteers, and representatives, or any of them, from any and all claims, demands, expenses, costs (including legal costs), suits, debts, liabilities and cause action for which UCM and its directors, officers, employees, agents, volunteers, and representatives, or any of them, may become liable as a result of any personal injury, death, loss or property damage resulting from, occasioned to or suffered by any person or property damage resulting from, occasioned to or suffered by any person or property as a result of any act or omission of ours or the Participant in connection with the Participants participation in the Activities.

 

Rules of Conduct, Termination of Participation and Waiver of Refund

  1. We recognize that participation in the Activities is a privilege and we understand and agree that as a participant in the Activities, the Participant must abide by all rules, regulations and directions imposed upon the Participant by UCM  and  its employees, agents, volunteers and representatives who will be accompanying participants in the Activities (the Chaperones), service providers and authorized representatives, and that the failure by the Participant to do so may result in the Participants participation in the Activities being terminated immediately.
  2. We understand and agree that UCM and its directors, officers, employees, agents, volunteers, and representatives, including without limitation its Chaperones, or any of them, shall have no responsibility to or for the Participant when the Participant is absent from the sanctioned events of the Activities, the Participant breaches the regulations and rules of the Activities or the Participant willfully departs the Activities without authorization.
  3. We recognize that it is the Participants sole responsibility to acquaint him/herself with all such rules and regulations established by UCM and its Chaperones, service providers and authorized representatives.
  4. We also understand and agree that as a result of the Participant disobeying any such rules, regulations and directions that the Chaperones may send the Participant home at my own expense, and that if the Participant is sent home this will also result in a waiver of the right to a refund of any part of the fee paid for the Activities.
  5. We also understand and agree that such termination of the Participants participation in the Activities will not relieve us from the obligation to pay any debt that we have incurred with respect to the Activities.

 

Medical/Emergency

  1. We declare that the Participant is physically able and not suffering from any condition, impairment, infirmity or illness that may limit or prevent the Participants participation in the Activities except as stated below.
  2. We acknowledge that all relevant medical conditions are reported to Chaperones, agents or employees of UCM prior to the activity
  3. We agree that UCM may, through its Chaperones, agents or employees, secure such medical advice and services as it, in its sole discretion, may deem necessary for the health and safety of the Participant in the event of an emergency, and that we shall be financially responsible for the provision of such emergency services.

Documentation and Insurance

  1. We understand that UCM does not carry insurance that would cover the Participant for participation in the Activities.
  2. We understand that it is our responsibility to ensure the necessary travel documents (including passport) and insurance, including but not limited to out-of-country medical insurance, accidental death, disability and dismemberment insurance and travel insurance, are secured prior to the Activities.

Miscellaneous

  1. We acknowledge that the Participant meets all of the prerequisites required for participation in the Activities and agree to ensure the Participant has adequate clothing and equipment to participate in the Activities.
  2. We understand that this consent, waiver, assumption of risk and indemnity agreement is a legal agreement and we agree to be bound by its terms.
  3. We did not rely upon any promises, inducements, representations or agreements, including but not limited to any oral statements made by or on behalf of UCM or its directors, officers, employees, agents, volunteers, and representatives, or any of them, the effect of which would be to modify or vary the terms of this agreement.
  4. We understand that the obligations of the Participant and the undersigned parents/guardians set out herein are joint and several.
  5. We understand that if any of the terms or conditions of this agreement or their application to any party or circumstances shall be held invalid by any court or other authority having jurisdiction the remainder of the agreement and the application to parties or circumstances other than those as to which it is held invalid shall not be affected.
  6. We understand that this agreement may only be amended or modified if it is amended or modified by BCCM and acknowledged in writing by us.
  7. We acknowledge and agree that this agreement shall be biding upon and enure to the benefit of our and the Participants respective heirs, successors, personal representatives and assigns.

 

We, the Participant named herein and the undersigned parents/guardians, acknowledge that we have read and fully understood this agreement and accept the risks of participating in the Activities.  (Parent/guardian signatures required for participants less than 19 years of age).

 

THIS FORM MUST BE COMPLETED IN FULL BEFORE THE PARTICIPANT WILL BE PERMITTED TO PARTICIPATE IN THE ACTIVITIES.

 




 

                                    

 

First Participants Name

First Name*

Last Name*

Phone*
First Participants Date of Birth*
First Participants Signature*
Second Participants Name

First Name*

Last Name*

Phone*
Second Participants Date of Birth*
Third Participants Name

First Name*

Last Name*

Phone*
Third Participants Date of Birth*
Fourth Participants Name

First Name*

Last Name*

Phone*
Fourth Participants Date of Birth*
Fifth Participants Name

First Name*

Last Name*

Phone*
Fifth Participants Date of Birth*
Sixth Participants Name

First Name*

Last Name*

Phone*
Sixth Participants Date of Birth*
Seventh Participants Name

First Name*

Last Name*

Phone*
Seventh Participants Date of Birth*
Eighth Participants Name

First Name*

Last Name*

Phone*
Eighth Participants Date of Birth*
Ninth Participants Name

First Name*

Last Name*

Phone*
Ninth Participants Date of Birth*
Tenth Participants Name

First Name*

Last Name*

Phone*
Tenth Participants Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Insurance

Insurance Carrier*

Insurance Policy Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver