THE GEOLOGICAL ASSOCIATION OF CANADA AND THE MINERALOGICAL ASSOCIATION OF CANADA
RELEASE OF LIABILITY - READ BEFORE SIGNING
Release of Liability in PDF format
Field Trip: ____________________________________________________________
Trip Leader: ____________________________________________________________
Meeting/Sponsor:________________________________________________________
Dates: ____________________________________________________________
SIGNING THIS DOCUMENT INDICATES THAT YOU UNDERSTAND THE RISKS ASSOCIATED WITH THIS FIELD TRIP AND THAT YOU ARE AWARE THAT BY PARTICIPATING IN IT, YOU ARE EXPOSING YOURSELF TO RISKS INCLUDING BUT NOT NECESSARILY LIMITED TO THOSE IDENTIFIED BY THE FIELD TRIP LEADERS.
Participant's name: _____________________________________________________
Emergency Telephone Contact: ____________________________________________
In consideration of being allowed to participate in any way in the GAC®/MAC
Field Trip
identified above, its related events and activities, I, _____________________________,
the undersigned, acknowledge, appreciate and agree that:
The risk of injury from the activities involved in this field trip is
significant, including
the potential for permanent paralysis and death, and while particular
skills, equipment, and
personal discipline may reduce this risk, the risk of serious injury
does exist; and,
I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERS, AND ASSUME FULL RESPONSIBILITY FOR MY PARTICIPATION; and.
I willingly agree to comply with the stated and customary terms and
conditions for
participation. I agree to follow the instructions and precautions as
written in the Field Trip
Guidebook and/or stated by the Field Trip Leaders. I assume responsibility
for attending all
safety briefings. If I observe any unusual significant hazard during
my presence or
participation in this Field Trip, I will remove myself from participation
and bring such to the
attention of the field trip leader immediately, and,
I, for myself and on behalf of my heirs, assigns, personal representatives
and next of kin,
HEREBY RELEASE, INDEMNIFY AND HOLD HARMLESS THE GEOLOGICAL ASSOCIATION
OF CANADA, THE MINERALOGICAL ASSOCIATION OF CANADA, their officers, agents,
and/or employees, volunteers, other
participants, sponsoring agencies, sponsors, advertisers, and, if applicable,
owners and
lessors of premises used for activity ("Releasees"), with respect to
any and all injury,
disability, death, or loss or damage to person or property, whether
arising from the negligence
of the Releasees or otherwise, to the fullest extent permitted by law.
I have read this release of liability and assumption of risk agreement,
fully
understand its terms, understand that I have given up substantial rights
by signing it, and
sign it freely and voluntarily without any inducement.
Participant's signature: _______________________________________________
Date and Place: _______________________________________________
Witness's signature: _______________________________________________
Witness's name (printed)
_______________________________________________
Emergency Contact Information (optional):
Emergency Contact's name: _______________________________________________
Emergency Contact's telephone: __________________________________________
Emergency Contact's relationship to participant ____________________________