Skip to content

"*" indicates required fields

Step 1 of 2

Waiver of Rights and Consent to Participate

***PLEASE READ CAREFULLY***

You are waiving certain legal rights by signing this document

I understand that this Waiver and Consent to Participate agreement is in addition to, and is not a substitute for, any other documentation or registration information that I might be required to execute by the Halifax Public Libraries (“HPL”) or the Halifax Regional Municipality (“HRM”), or by its supporting organizations, in order for me to participate in the activity.

In consideration of HPL offering me the opportunity to participate in the following activity, on the date(s) associated with that activity, I give and provide HPL with my consent for me to participate in the following activity:

Description of Activity and Potential Risks Specific to the Activity:

  • Receiving a bicycle, and other equipment, if applicable, on loan from HPL
  • Operating the bicycle for the period of time permitted

Dates and Times of Activity:

YYYY dash MM dash DD
Time*
:
YYYY dash MM dash DD
Time*
:

By signing this agreement, I acknowledge that the nature of the activities in which I am participating may involve risks and dangers of serious bodily injury, including (but not limited to) permanent disability, paralysis and death. These risks and other similar dangers may be caused by my own actions, or inactions, the actions, or inactions, of others participating in the activity or the circumstances in which the activity takes place. There may be other risks and dangers and social and economic losses neither known to me nor readily foreseeable at this time (the risks and dangers set forth in this section, and, as written above, are collectively the “Risks”).

I KNOWINGLY AND VOLUNTARILY AGREE TO ASSUME, ON BEHALF OF MYSELF, MY HEIRS, PERSONAL REPRESENTATIVES AND NEXT OF KIN, ALL SUCH RISKS AND ACCEPT ALL RESPONSIBILITY FOR ANY INJURY TO MYSELF (INCLUDING, BUT NOT LIMITED TO, PERSONAL INJURY, DISABILITY, AND DEATH), ILLNESS, DAMAGE TO PROPERTY, LOSS, CLAIM, LIABILITY, OR EXPENSE, OF ANY KIND (COLLECTIVELY THE “CLAIMS”) THAT I MAY EXPERIENCE OR INCUR IN CONNECTION WITH MY ATTENDANCE AND/OR PARTICIPATION IN THE ACTIVITY.

I HEREBY RELEASE, INDEMNIFY, COVENANT NOT TO SUE, WAIVE MY RIGHT TO BRING AN ACTION, DISCHARGE, AND HOLD HARMLESS HALIFAX PUBLIC LIBRARIES AND THE HALIFAX REGIONAL MUNICIPALITY, ITS MAYOR, COUNCILLORS, EMPLOYEES, AGENTS, AND REPRESENTATIVES, OF AND FROM THE CLAIMS, INCLUDING ALL LIABILITIES, CLAIMS, ACTIONS, DAMAGES, COSTS OR EXPENSES OF ANY KIND ARISING OUT OF OR RELATING TO MY ATTENDANCE AND/OR PARTICIPATION IN THE ACTIVITY UNLESS SUCH LIABILITIES, CLAIMS, ACTIONS, DAMAGES, COSTS OR EXPENSES ARE A DIRECT RESULT OF HPL’S OR HRM’S GROSS NEGLIGENCE OR WILFUL MISCONDUCT.

PARTICIPANT NAME*
YYYY dash MM dash DD

If the participant is under 19 years of age, the participant’s parent or legal guardian is required to sign.

I am the parent or legal guardian of the participant who I certify is under the age of 19. I also certify that I have the legal authority to represent and bind the participant. I have read these Terms and Conditions and, on behalf of the participant, voluntarily agree to be bound by its provisions.

PARENT OR LEGAL GUARDIAN
YYYY dash MM dash DD
WITNESS
YYYY dash MM dash DD