APPENDIX 6
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  ____________________________
 
 


Last modified: June 28, 2007
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