Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

ACKNOWLEDGMENT OF RESPONSIBILITY LIABILITY WAIVER Queen s University Exchange Program by bluffdaddy

VIEWS: 214 PAGES: 2

									ACKNOWLEDGMENT OF RESPONSIBILITY & LIABILITY WAIVER


                                           Queen's University Exchange Program

           ACKNOWLEDGMENT OF RESPONSIBILITY & LIABILITY WAIVER

I understand that participation in a Queen's University Exchange Program will take me away from
campus for an extended period of time. During this period I understand that I will be exposed to risks to
my person and I am prepared to accept these risks.

In consideration of the opportunity provided by Queen s University to participate in this program, I
hereby release and hold harmless Queen's University, its agents and employees, from any and all
liability for any loss, damage, injury or expense that I may suffer, or that my next of kin may suffer, as a
result of my participation in this program due to any cause whatsoever including, but not limited to,
negligence, breach of contract or breach of any statutory or other duty of care, delay, expense resulting
from events beyond their control, acts of God, war, civil unrest, sickness, transportation, scheduling
and government restrictions or regulations.

I further understand that it is my responsibility to abide by all applicable University policies, the laws of
the host country, and to ensure that I have adequate medical, personal health, dental and accident
insurance coverage, as well as protection of my personal possessions.

I recognize that in the event of a general civil emergency, the University, through the Government of
Canada, will endeavour to assist its students.

It is understood that my supervisor or exchange coordinator can require my withdrawal from the
program for reasons of illness or conduct unbecoming a student of Queen's University and will be the
sole authority in exercising that judgment.

For the purpose of this waiver, the period of time I am participating in a Queen's University Exchange
Program will correspond to the academic program dates of the institution I am attending.

I understand that this agreement cannot be modified or interpreted except in writing by Queen's
University and that no oral modification or interpretation shall be valid.

I appoint the following person my Designated Next of Kin and authorize the University to contact that
person for or with information about me in my absence.

Name: ____________________________________________________________________________
Address: __________________________________________________________________________
Telephone: _________________________________________________________________________
Date: ________________________________

I have fully informed my Next of Kin regarding all aspects of my proposed study including the nature of
any possible risks.

I ACKNOWLEDGE MY OBLIGATIONS AND RESPONSIBILITIES.

Participant Name: ___________________________________________________________________
Address:


http://law.queensu.ca/students/International/waiver.htm (1 of 2)9/28/2006 3:02:30 PM
ACKNOWLEDGMENT OF RESPONSIBILITY & LIABILITY WAIVER

___________________________________________________________________________
Telephone:
_________________________________________________________________________
Signature: ________________________________________

Witness: __________________________________________________________________________
Date: ____________________________________




http://law.queensu.ca/students/International/waiver.htm (2 of 2)9/28/2006 3:02:30 PM

								
To top