This is in consideration of my voluntary participation in the OCAD U Internship or Work and Community Integrated

Learning Program (the "Program"), to take place with the Placement Organization (the "Organization"):
Organization Name: Johnson & Johnson

Organization Supervisor: Mary Quandt

Organization Address: 601 W 26th St. 16th fl

Organization Supervisor Phone:

Organization Phone: (732) 524-0400

Organization Email: mquandt@its.jnj.com

ASSUMPTION OF RISK AND RESPONSIBILITY

1.

I hereby acknowledge that participating in the Internship is a potentially dangerous activity and may cause
personal injury to my person and/or possessions or death. I assume all risks of loss or injury to my own personal
property and person and/or to the personal property or persons of others that may occur by reason of my
participation in the Internship.

2.

I acknowledge that the Internship will take place away from campus and I acknowledge that the University will
not be able to ensure my safety or exposure to any risks, dangers, and hazards to my person or my possessions.
I understand that the University will not supervise any of the Organizations work environment during my
participation in the Internship.

3.

I understand that I will remain a student of the University during the term of the Internship and will therefore be
obligated to comply with all of the rules, regulations, and policies of the University during such term.

4.

I shall ensure that I have made appropriate travel and accommodation arrangements necessary during the term
of the Internship, and that I have adequate and sufficient information and resources to complete the Internship
safely.

5.

I acknowledge that neither the University nor the Organization shall carry accident or injury insurance for my
benefit and there may be certain matters for which I could be held financially responsible and at fault personally.
I acknowledge that I am accountable in all respects for my own actions, omissions, and negligence and I shall
not ask the University or the Organization, or their parent and affiliated companies, or any of their respective
officers, directors, governors, trustees, employees, agents, or contractors to assume or accept the
consequences thereof.

6.

I shall be responsible for any claims made against the University, its parent and affiliated companies, or any of its
officers, directors, governors, trustees, employees, agents, or contractors in relation to my actions, omissions, or
negligence during the Internship.

RELEASE, WAIVER OF LIABILITY, AND INDEMNITY

1.

In consideration for being permitted to take part in the Internship, I hereby grant a full and final release to, and
waive as against, the University, its parent and affiliated companies, each of their respective officers, directors,
governors, trustees, employees, agents, and contractors, and each of their successors, heirs and assigns
(collectively, the Releasees) from any and all losses, liabilities, damages, injuries, claims, demands, lawsuits,
costs, expenses (including legal fees and disbursements), and any other liability of any kind whatsoever both in
law and in equity or under any statute or regulation (each a Claim) that I, my heirs, executors, representatives,
successors, or assigns, or any of us now have or may have against one or more of the Releasees, for or by
reason of any cause, matter, or thing whatsoever arising out of or in any way related to my participation in the
Internship, including any Claims arising from the negligence or gross negligence of any of the Releasees.

2.

I shall indemnify and hold harmless the Releasees from any and all losses, liabilities, damages, injuries, claims,
demands, lawsuits, costs, expenses (including legal fees and disbursements), and any other liability of any kind
whatsoever both in law and in equity or under any statute or regulation, including negligence, howsoever arising
out of or in connection with my participation in the Internship.

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3.

I hereby acknowledge that the University shall not be liable for any failure or delay in performing its obligations
under this Agreement due to causes outside its reasonable control.

CODE OF CONDUCT:
I acknowledge that as a Student who is participating in the Program, I will be a representative of OCAD University for
the duration of my time in the Program, and that I am expected to conduct myself professionally while abiding by the
rules set forth by OCAD University, the course faculty, and the Organization, including but not limited to:
1.

Discussing beforehand with the Centre for Students with Disabilities at OCAD University, any disability-related
accommodations I may require during my participation in the Internship;

2.

Complying with all of the rules, regulations, policies, and procedures, including those related to work schedules
and health and safety, of the Organization during the term of the Internship, and complying with the instructions
given to me by my supervisor;

3.

Wearing such protective equipment and clothing as is suitable in the circumstances, and exercising reasonable
precautions for my own safety and the safety of others;

4.

Demonstrating professional behavior including being punctual, using appropriate written and oral communication,
respecting the workplace dress code, and treating clients and colleagues with professional dignity and respect;

5.

Refraining from engaging in personal business while at work (e.g. checking personal email, texting friends etc);

6.

Not being under the influence of any drugs, alcohol, or hallucinogenics during the Internship and will bringing
any such items onto the premises of the Organization; and

7.

Taking precautions necessary to prevent or deal with any known health complications that may arise during the
term of the Internship.

DECLARATION
1.

I hereby declare that I am a resident of the Province of Ontario and have reached the age of majority in the
Province of Ontario. I acknowledge that this Agreement is subject to and shall be interpreted in accordance with
the laws of the Province of Ontario and the federal laws of Canada related thereto and hereby attorn to the
jurisdiction of the courts of the Province of Ontario.

2.

I understand that my personal information shall be collected, used, and disclosed by the University for the
purposes stated in this Agreement.

3.

I hereby acknowledge that the University reserves the right, in its sole discretion, to cancel or suspend part or all
of the Internship at any time.

4.

I understand that, during the Internship, it may be necessary or desirable for the University or the Organization to
disclose proprietary, trade secret, and/or other confidential information (Confidential Information) to me. I
acknowledge and agree that all Confidential Information shall remain the property of the party disclosing same.
The Confidential Information shall only be used for purposes of the Internship and originals and copies thereof
shall be destroyed or returned to the disclosing party at the end of the Internship. All Confidential Information
shall be treated as confidential by me for one (1) year following completion of the term of the Internship.

5.

I acknowledge that the invalidity or unenforceability of any provision of this Agreement shall not affect the validity
or enforceability of the remaining provisions of this Agreement.

6.

I acknowledge that I do not have the right to assign this Agreement and that this Agreement may only be
modified in writing by myself and the University.

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7.

I acknowledge that this Agreement shall survive termination of the Internship and shall enure to the benefit of
and shall be binding on me, my heirs, next of kin, executors, administrators, representatives, successors, and
assigns.

8.

I hereby declare that I have carefully reviewed the foregoing, that I fully understand its contents, and that I have
entered into this Agreement of my own volition.

EXECUTED at

New York City , Ontario, this

27

April

day of ________, 20__.

I HAVE READ THIS DOCUMENT CAREFULLY AND I ACKNOWLEDGE MY

RESPONSIBILITIES AND THE EFFECT OF THIS LIABILITY WAIVER

PLEASE PRINT

Participant Name:

Permanent Address:

Yifei (George) Wang

Student Number:

2553923

714-75 Norman Bethune Ave.

(street, city, province, postal code)

647
Permanent Telephone: (_____)

300-0234

Juzer Sharafali

Friend

Emergency Contact Name: _____________________________ Relationship to Student: ______________________

Emergency Contact Phone Numbers:

525-9358

647
(_____)______________________
(Home Phone Number)

(_____)______________________

(_____)____________________

(Work Phone Number)

(Signature of Participant, or parent/guardian if under 18 years of age)

(Cell Phone Number)

(Date)

(Name of Witness)

(Signature of Witness)

OCAD University
www.ocadu.ca
100 McCaul Street, Toronto, Ontario Canada M5T 1W1
TELEPHONE 416.977.6000 FACSIMILE 416.977.6006

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