School of Industrial Design
Informed Consent and Waiver Form (all participants must sign)
I, _______________________(name of user) in consideration of my use of the Industrial Design laboratory and studio facilities at
Carleton University, 1125 Colonel By Drive, Ottawa Ontario, during the period from July 5 2015 to July 31 2015 acknowledge
Carleton University, its Board of Governors, employees, servants or Agents shall not be liable for any injury to my person or loss or
damage to my personal property arising from, or in any way resulting from my use of the laboratory and studio facilities at Carleton
University and/or the activities associated with their use.
I understand there are potential risks inherent in my use of the laboratories and studios, such as minor or serious injuries resulting
from my actions or inactions, or the actions or inaction of others, or a combination of both. My use of the laboratories and studios is
acknowledgment of the inherent risks involved, and my willingness to assume those risks.
I hereby release Carleton University, its Board of Governors, employees, servants or agents, and all others who are involved from all
actions, claims and demands that I may at anytime have now or in the future against them for liability of any kind arising out of the
use of the Industrial Design Laboratories and Studios at Carleton University.
For the purposes of this agreement, the Design Laboratories and Studios are defined as Wood Lab, Room 217AA; the Mould
Simulation Lab, Room 2460ME, the Paint Booth, Room 2464ME, the Sewing Room, 2496ME, the Vacuum Forming Room, 2495ME,
the Mass Production Lab, Rooms 2463 & 2493ME and the Metal Lab, Room 2448ME and Studios Rooms 3473ME, 3475ME, 3490ME
during both supervised and unsupervised times.
I further agree and understand that I am solely responsible for damages I may cause to equipment or contents of the laboratory or
studios. I agree to reimburse the University for such damage, and acknowledge the cost to repair or replace such damaged
equipment or contents shall be deemed as a debt to the University, and shall be subject to the University’s policy on delinquent
accounts published in the University calendar.
I understand it is my responsibility to attend and complete the lab introductory sessions before using any of the Industrial Design
laboratory facilities. I will not use any tools or equipment for which I have not received training in its use and operation. I agree to
abide by all rules imposed on my use of the laboratories.
I further agree to abide by any decisions, which may prevent me from using the laboratory, or any equipment, tools or objects
located within.
School of Industrial Design – Informed Consent and Waiver
I _____________________ (name of user) have read and understood the above statements.
Name
Signature
User
Parent/Guardian
Witness
Address and Phone
Number of User
Address of
Parent/Guardian
Please fill out this form on the computer, then email to shad@carleton.ca
AND print and bring the original signed copy with you.
Copies of the form can be downloaded to fill out at http://shad.carleton.ca/
Date