WORK INTEGRATED LEARNING PARTICIPATION RISK ACKNOWLEDGEMENT and INFORMED CONSENT

Based on the risks identified above, I hereby acknowledge and agree to the following:
	I agree:
Transportation: I understand that the University Of Ontario Institute Of Technology (“Ontario Tech”) is not responsible for the insurance of any personal vehicles and/or vehicles leased/rented or temporarily used while travelling to and from the Work Integrated Learning.	Transportation: I understand that the University Of Ontario Institute Of Technology (“Ontario Tech”) is not responsible for the insurance of any personal vehicles and/or vehicles leased/rented or temporarily used while travelling to and from the Work Integrated Learning.I agree:
Weather: I understand that my attire is my responsibility and that I will wear attire that is safe and appropriate for the Work Integrated Learning and the contemplated activities. For further clarity, I will take into consideration any weather conditions which may put me at risk of any injury or illness due to exposure from heat, sunlight, humidity, wind, or inclement weather.	Weather: I understand that my attire is my responsibility and that I will wear attire that is safe and appropriate for the Work Integrated Learning and the contemplated activities. For further clarity, I will take into consideration any weather conditions which may put me at risk of any injury or illness due to exposure from heat, sunlight, humidity, wind, or inclement weather.I agree:
Environmental Conditions: I agree to maintain an acute awareness of my surroundings during my participation in the Work Integrated Learning in order to prevent possible injury to myself and/or others caused by distraction or failure to recognize potential hazards.	Environmental Conditions: I agree to maintain an acute awareness of my surroundings during my participation in the Work Integrated Learning in order to prevent possible injury to myself and/or others caused by distraction or failure to recognize potential hazards.I agree:
Facilities and Equipment: I agree to follow the direction of my supervisor and/or or any third party involved in the delivery of goods or services related to the Work Integrated Learning (“Program Partner”) as it relates to the proper use of the facilities, and equipment to ensure the safety and wellbeing of myself and others. I understand that the use or non-use of facilities, equipment, or protective personal equipment, contrary to the instruction provided, may result in damage to property or injury to myself, and/or others. For further clarity, I agree to follow the appropriate safety rules and/or regulations that may apply to my participation in the Work Integrated Learning.	Facilities and Equipment: I agree to follow the direction of my supervisor and/or or any third party involved in the delivery of goods or services related to the Work Integrated Learning (“Program Partner”) as it relates to the proper use of the facilities, and equipment to ensure the safety and wellbeing of myself and others. I understand that the use or non-use of facilities, equipment, or protective personal equipment, contrary to the instruction provided, may result in damage to property or injury to myself, and/or others. For further clarity, I agree to follow the appropriate safety rules and/or regulations that may apply to my participation in the Work Integrated Learning.I agree:
Activities: I confirm that I am in good health and in proper physical condition to safely participate in the Work Integrated Learning. I understand that it is my responsibility to continuously monitor my own physical and mental condition during the Work Integrated Learning, and I agree to withdraw immediately from the activities of the Work Integrated Learning and inform my Supervisor and/or third party involved in the delivery of goods or services related to the Work Integrated Learning (“Program Partner”) of any changes in health or ability if at any point my continued participation would create a risk of injury to myself and/or to others.	Activities: I confirm that I am in good health and in proper physical condition to safely participate in the Work Integrated Learning. I understand that it is my responsibility to continuously monitor my own physical and mental condition during the Work Integrated Learning, and I agree to withdraw immediately from the activities of the Work Integrated Learning and inform my Supervisor and/or third party involved in the delivery of goods or services related to the Work Integrated Learning (“Program Partner”) of any changes in health or ability if at any point my continued participation would create a risk of injury to myself and/or to others.I agree:

In order to safeguard my physical health and safety and that of my fellow students, and to protect the good name and reputation of Ontario Tech while on any Work Integrated Learning:
	I agree
I agree to carry a copy of my emergency contact with me and/or ensure I have my provincial health plan/university health insurance plan card on my person in the case of an emergency.	I agree to carry a copy of my emergency contact with me and/or ensure I have my provincial health plan/university health insurance plan card on my person in the case of an emergency.I agree
I agree to inform my Supervisor of any known allergies to food or the environment and to communicate any required accommodations to ensure my safe participation during the Work Integrated Learning.	I agree to inform my Supervisor of any known allergies to food or the environment and to communicate any required accommodations to ensure my safe participation during the Work Integrated Learning.I agree
I agree to inform my Supervisor of any medication(s) that I may need assistance to use during the Work Integrated Learning (such as insulin, epi-pen, inhaler, etc.), and to carry such medication(s) on my person at all times while participating in the Work Integrated Learning. I may require, and agree to carry on my person at all times during the Work Integrated Learning, the following medication(s):	I agree to inform my Supervisor of any medication(s) that I may need assistance to use during the Work Integrated Learning (such as insulin, epi-pen, inhaler, etc.), and to carry such medication(s) on my person at all times while participating in the Work Integrated Learning. I may require, and agree to carry on my person at all times during the Work Integrated Learning, the following medication(s):I agree
I understand that, during my participation in the Work Integrated Learning, I am responsible for my own property insurance.	I understand that, during my participation in the Work Integrated Learning, I am responsible for my own property insurance.I agree
I agree to observe and adhere to all public laws and ordinances, including traffic laws as well as the usages and customs of good citizenship, decorum, and courtesy.	I agree to observe and adhere to all public laws and ordinances, including traffic laws as well as the usages and customs of good citizenship, decorum, and courtesy.I agree
I agree to observe and adhere to all rules of Ontario Tech or Program Partner agency that apply to visitors and/or the general public and/or to participation in the Work Integrated Learning.	I agree to observe and adhere to all rules of Ontario Tech or Program Partner agency that apply to visitors and/or the general public and/or to participation in the Work Integrated Learning.I agree
I agree to observe and adhere to all Ontario Tech policies relevant to my participation in the Work Integrated Learning, including but not limited to the Student Code of Conduct. I agree to act in accordance with such policies at all times, representing Ontario Tech in a professional manner.	I agree to observe and adhere to all Ontario Tech policies relevant to my participation in the Work Integrated Learning, including but not limited to the Student Code of Conduct. I agree to act in accordance with such policies at all times, representing Ontario Tech in a professional manner.I agree

PHOTO/VIDEO ACKNOWLEDGEMENT AND AUTHORIZATION

By selecting the first box below, I hereby grant to Ontario Tech (including its employees, contractors and Program Partners) the permission:

(a) to photograph, audio record, video record, podcast and/or webcast me, digitally or otherwise, without charge;

(b) to use my name, and any photographs or recordings of my image, voice or likeness (the “Image”); and

(c) to use, copy, modify, distribute, publish and reproduce my Image, in whole or in part, in all forms and in any medium, whether now known or hereafter devised, including but not limited to advertisements, articles, publications, posters, pamphlets, websites, podcasts, videos, and social media platforms for promotional, marketing and communication purposes (the “Permitted Purpose”) without prior notice or further approval.

I acknowledge and agree that I will not be entitled to receive any compensation, fees or royalties of any kind relating to the use of my Image.
I acknowledge and agree that participation is strictly voluntary, and that the consent given in this section may be revoked at any time upon written notice to Ontario Tech. I understand revocation of consent will be effective as of the date of receipt and will not be applied retroactively. I DO grant permission for the use of my Image and agree to the terms above I DO NOT grant permission for the use of my Image

WORK INTEGRATED LEARNING PARTICIPATION RISK ACKNOWLEDGEMENT and INFORMED CONSENT

WORK INTEGRATED LEARNING PARTICIPATION RISK ACKNOWLEDGEMENT and INFORMED CONSENT

Understanding of Risk