ESQ Waiver Release and Indemnity – STEM CLUB

ESQ Waiver Release and Indemnity – STEM Club

Please note: This opportunity is provided through a third party and therefore BBBSWR does not assume any responsibility or liability for outcomes or consequences. Participation in these opportunities is done so at your own discretion. All information collected in this form is collected for the use by The University of Waterloo Engineering Science Quest (ESQ) Program.

Child Name(Required)

First Last

Child Age(Required)

How would you describe your child's gender identity?

Gender Identity (if not listed):

Caregiver Name(Required)

First Last

Phone(Required)

Email(Required)

List of Authorized Pick-Up Names (named matches photo ID)(Required)

Publicity Consent:

I understand and agree that the University of Waterloo shall have the right to take photographic, sound or film recordings (“Multimedia Recordings”) of the Participant’s participation in the ESQ program, and agree that the University of Waterloo may use any such Multimedia Recordings for administrative, educational and promotional purposes. I hereby waive and irrevocably assign to University of Waterloo any rights I may have to such Multimedia Recordings, including any moral or other rights.

Multimedia Recordings Consent(Required)

Yes

Wavier, Release and Indemnity

1. I acknowledge and understand that, as a result of the Participant’s participation in the ESQ program, the Participant will be engaging in activities (including, but not limited to, various science-related activities, educational projects and physical activities) that involve risk of damage to, or loss of, personal property or bodily injury, and social and economic losses, which might result not only from my or the Participant’s actions, inactions or negligence, but the actions, inactions or negligence of others, including other ESQ program participants and their parents or guardians and the employees and volunteers of the University of Waterloo, the condition of the ESQ program facilities, or weather conditions during the Participant’s participation in the ESQ program, and I further acknowledge that there may be other risks not known or not reasonably foreseeable as at the date of this signing this Agreement (collectively, the “Risks”).

2. I, on behalf of myself and the Participant, voluntarily assume all of the Risks and accept personal responsibility for any and all loss, damage, expense (medical or otherwise) or injury, that I or the Participant may suffer, or that my or the Participant’s heirs or next of kin may suffer, as a result of the Participant’s participation in the ESQ program. I understand that the Risks simply cannot be eliminated without jeopardizing the essential qualities of the ESQ program’s activities.

3. I release, waive, discharge and covenant not to sue the University, its governors, officers, faculty, students, employees, volunteers, independent contractors, agents and representatives or their respective affiliates (collectively, the “Releasees”) from any and all liability to the Participant, me, or my or the Participant’s heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including permanent disability, death or damage to property (collectively, “Claims”) caused or alleged to be caused in whole or in part by the Releasees negligence, breach of any duty of care, including any statutory duty, breach of contract, or any other act of the Releasees as a result of or in connection with, the ESQ program. I agree to hold harmless and to indemnify the Releasees from any and all Claims of any third party resulting from the Participant’s participation in the ESQ program.

4. I understand that the ESQ program has a violence-free policy to ensure the safety of all ESQ program participants. Any behavioural misconduct by the Participant in violation of this policy may result in immediate removal of the Participant from the ESQ program, with no money refunded.

5. I hereby consent to the Participant completing a post-program feedback form to assess the Participant perspectives of the program. The introduction to the form states that it is optional. The feedback responses cannot be linked to the individual who completed the survey, they are anonymous. The feedback form is administered either via an online form or a print-out copy and used by Waterloo Engineering Outreach and Actua, a third-party organization and national charity for program evaluation. The University has been an Actua network member since 1990 and receives program funding for Engineering Outreach operations.

6. This Waiver, Release and Indemnity will be binding upon me and my heirs, next of kin, executors, administrators, assigns and representatives and will ensure to the benefit of the University of Waterloo and the other Releasees and their respective heirs, next of kin, executors, administrators, representatives, assigns, affiliates and successors.

I have read and understood the above Waiver, Release and Indemnity. In consideration of the Participant’s participation in the ESQ program, the Participant and I hereby agree to be bound by the above Waiver, Release and Indemnity.(Required)

Yes

Caregiver Signature(Required)

First Last

Date(Required)

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