UNSW College Risk Warning, Acknowledgement of Risk and Waiver

Name*

First NameLast Name

Student ID Number*

ZID, CID or GID

Class Group / Number*

E.g. UEEC 20 - 07

Please write the name of the activity/excursion you are register for?*

e.g. TOP Milsons Point to Circular Quay

Date of the activity*

Date

Please list any known medical conditions or allergies you may have

If none, please skip

Please list any current medication you are taking

If none, please skip

By signing this form you acknowledge and agree:

1. That participation in any social and/or sporting activity including, without limitation:

a. recreational activities, such as picnics, sporting competitions, boat cruises, BBQs, dances, fetes and fairs etc; or

b. dangerous recreational activities, such as horse riding, skiing, snowboarding, recreational activities involving the consumption of alcohol, or recreational activities that involve sudden changes to the physical environment, for example, ocean swimming; or

c. any activity identified in this document, provided by UNSW College Pty Ltd (UNSW College) and/or its agents (UNSW College Activity) may involve elements of risk, whether obvious or not.

2. The risks involved in participating in any UNSW College Activity may include, but are not limited to, personal injury, death, or property damage.

3. Prior to undertaking any UNSW College Activity, you have considered all the risks involved, including those risks associated with any medical condition that you have which might reasonably affect your safe involvement.

4. Your participation in any UNSW College Activity is voluntarily.

5. You voluntarily assume all risks of any harm, injury or damage that you may suffer, whether foreseen or unforeseen, in connection with the UNSW College Activity.

6. To the full extent permitted by law, you or your heirs, successors, executors, administrators, agents and assignees agree to waive and/or release UNSW College and its officers, employees and/or its agents, from any and all claims, actions or losses, or for any bodily injury, property damage, wrongful death, loss of services or otherwise, which may arise out of participation in, or in relation to, any UNSW College Activity.

7. You understand that you are releasing, discharging, and waiving any claims or actions that you may have presently or in the future relating to your participation in any UNSW College Activity.

8. That UNSW College has permission, during the UNSW College Activity, to take photographs and/or video footage containing your image.

9. That UNSW College may use any photographs and/or video footage containing your image for an unlimited period without remuneration in any media now known or hereafter devised for the purpose of promoting UNSW College, including reproduction online or in UNSW College promotional materials.

10. That UNSW College may arrange emergency medical assistance for, or administer first aid to, you in connection with the UNSW College Activity if UNSW College considers that this is required.

11. That if any provision of the document is found to be unenforceable or invalid, that provision shall be severed from this document and the remainder of this document shall continue in full legal force and effect.

PLEASE NOTE: THIS IS AN IMPORTANT DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS AND OBLIGATIONS. PLEASE READ IT CAREFULLY AND DO NOT SIGN IT UNLESS YOU ARE SATISFIED THAT YOU UNDERSTAND IT.

DECLARATION:

I understand and agree to the above terms and conditions

Signature*

Date*

DateHourMinutesAM/PM Option

Privacy Statement:
This form, and the management of any Personal or Sensitive Information collected, complies with the UNSW College Privacy Policy and the Privacy Act 1988 (Cth). The Personal Information collected on this form, which includes Sensitive Information, such as health information, is for the primary purpose of best managing any health or safety emergency that may involve you during any UNSW College Activity. Other purposes of collection include, but are not limited to, eliminating or minimising the risk of aggravating any pre-existing injury or illness that you are aware of and disclose. If you choose not to complete all the questions on this form, it may not be possible for UNSW College, its staff or agents supervising the UNSW College Activity to provide the best possible response in any emergency involving you. Personal Information may also be disclosed to emergency services personnel or medical personnel, where necessary.