Release and Waiver Form

RELEASE, WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

(Hereinafter referred to as the “Agreement”)

  1. IN CONSIDERATION OF being accepted to participate in the

Everest Region Field Study
Program in Nepal in 2012 (hereinafter referred to as
the “PROGRAM”)

I, the undersigned hereby RELEASE,
WAIVE, HOLD HARMLESS AND FOREVER DISCHARGE

INTERNATIONAL INSTITUTE OF FIELD
STUDIES, having its registered office in Hinton, Alberta, and its program coordinator, co-leader and associates (hereinafter referred to as the “RELEASEES”)

from any and all liability,
claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, death, illness or injury that may be sustained by me while participating in the Program activity, or while in, on, or upon the premises where the activity is being conducted or in the course of traveling
thereto.

  1. FURTHER, I ACKNOWLEDGE that in the event that I breach any of the rules and regulations or code of conduct by my behaviour, act or omission while participating in the Program, or in the event that I behave in a manner that is deemed unacceptable by the individual or individuals in charge of the Program activity, I may be asked to withdraw from the Program, and in that event I assume full responsibility for my own expenses after that time, and I do hereby RELEASE, HOLD HARMLESS AND DISCHARGE the Releasees from any loss, liability, claims or costs that I may incur as a result thereof.
  1. I FURTHER AGREE TO INDEMNIFY AND HOLD HARMLESS the Releasees from any loss, liability, damage or costs that I may incur as a result of my participation in the Program.
  1. IT IS MY intent and I HEREBY EXPRESSLY AGREE that this Agreement shall bind the members of my family, spouse, and heirs, assigns and personal representatives.
  1. I FURTHER AGREE that this Agreement shall be bound by the laws of the Province of Alberta, and any dispute arising out of it shall first be submitted to arbitration by a person or persons agreed to by me and the Releasees or, failing agreement, as may be assigned by a court of law.
  1. IN SIGNING this Agreement I ACKNOWLEDGE AND CONFIRM that I have read the foregoing, understand it and sign it voluntarily as my own free act and deed; thatno oral assurance, inducement,
    statement or representation, apart from the foregoing written Agreement, has been made to me; that I am at least eighteen (18) years of age and fully competent; and that I execute this Agreement for full, adequate and complete consideration, fully intending to be bound by the same.

IN WITNESS WHEREOF, I have hereunto set my hand and seal on this

______________ day of____________ , A.D. 201____

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(Signature of WITNESS)
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(Signature of PARTICIPANT)
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(Full name in Block Capital)
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(Full name in Block Capital)
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(Address)
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(Address)
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