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Canadian Conference on Student Leadership 2009At York University

Thursday, November 12 to Sunday, November 15, 2009

FULL NAME (First and Last)EMAIL ADDRESSPHONE NUMBERConference Options: -

Choose only ONE

Option #1 – FullPRICECHOICE

Nov 12 to 15: inclusive of 3nights stay, *all meals,seminars, games and activitiesincludedYork is Umember $50.00York is Uvolunteer $60.00

Stay at Founders Residence at Keele Campus.**Regular fee to register for this conference is $200!!

METHOD OF PAYMENT

– Select One

METHODCHOICE

CASHCHEQUE (Payable to York is U)I HEREBY SIGN THAT THE CORRECT AMOUNT OF MONIES REQUIRED FOR MYCHOICE IS ENCLOSED ____________________________________________ SignatureDate

EMERGENCY CONTACT INFORMATIONVOLUNTEER’S FULL NAME (First and Last)CONTACT’S FULL NAME (First and Last)CONTACT’S EMAIL ADDRESSCONTACT’S PHONE NUMBERVOLUNTEER’S RELATIONSHIP TO CONTACT********************************************************************************************

Personal Information

Please list any dietary restrictions and/or allergy information:

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________

Please list any special needs or requirements:

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________ *Once all forms have been processed, Membership Director, Mina will follow up withfurther details.

RELEASE OF LIABILITY, WAIVER OF CLAIMS,ASSUMPTIONS OF RISKS AND INDEMNITY AGREEMENTWARNING: BY SIGNING THIS DOCUMENT YOUWILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUEPLEASE READ CAREFULLY

NAME OF PARTICIPANT AND STUDENT ID# (PLEASE PRINT):FULL ADDRESS AND TELEPHONE NUMBER:ACTIVITY:

ASSUMPTION OF RISK

I am aware that

participating in the CCSL 2009 has some inherent risks

including but notlimited to:1.Lost or stolen property;2.Bodily injury during activities;3.Emotional or physical harm by another attendeeI freely accept and fully assume all risks, dangers and hazards and the possibility of personal injury,death, property damage or other delay or inconvenience resulting from acts or omissions, includingnegligence of York University, York is U, volunteers, students, event coordinators, and eventorganizers.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMITY AGREEMENT

In consideration of York University, or its faculty, employees, students, or volunteers allowing meto participate in University sponsored activities or extra curricular sporting, recreational, social or personal fulfillment activities, I hereby agree as follows:1.TO WAIVE ANY AND ALL CLAIMS that I have or may have in the future against York University, York is U and all other parties involved in this event (all of whom are hereinafter collectively referred to as “Releases”)2.TO RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense that I may suffer or that I may suffer as a result of my participation in the activitydue to any cause whatsoever INCLUDING NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING DUTYOF CARE UNDER THE OCCUPIERS’ LIABILITY ACT, RSO 1990 c o.2 ASAMENDED ON THE PART OF THE RELEASEES. ______

(initial here if you have read all the above)

3.TO HOLD HARMLESS AND INDEMNITY THE RELEASEES from any and all liabilityfor any damage to the property of or to any third party, resulting from my participation inthis event and3