Minorparticipant Release and Waiverof Liability, Assumption of Risk and Indemnity Form

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MinorParticipant Release and Waiverof Liability, Assumption of Risk and Indemnity Form

To the secretariat of the United Nations Framework Convention on Climate Change, its Kyoto Protocol and the Paris Agreement (the UNFCCC secretariat)
In consideration for allowing a representative under the age of sixteen (16) (hereinafter referred to as the “minor”) to participate in the below mentioned conference/meeting, who has been nominated by a Designated Contact Point along with a nominated chaperon,specified below -

Chaperon:

Full name: Ms./Mr.
Date of birth (age):
Resident of:
Mobile number:
Nominator (Organization):
Conference/meeting:

I, the chaperon named above,am responsible for the minor(s)whose details are provided in the attached list and confirm that participation of the minor(s) in the conference/meeting is with the consent of their parent/s/legal guardian/s and that they are fully aware of all the inherent risks associated with the participation of the minor(s) in the conference/meeting.

I agree that any damages caused by the minor(s) will be paid by me to the owners of the damaged item(s) and/or property.

I voluntarily assume all risks of personal injury, including temporary or permanent disability or death, property damage, economic losses, and/or other damages to the minor(s) resulting from or in any way associated with the minor(s) entry on the United Nations premises to participate in the conference/meeting. I undertake to be exclusively and personally responsible for the welfare, well-being, safety and security of the minor(s) on the United Nations premises during the conference/meeting.

I further acknowledge and agree that this Waiver of Liability, Assumption of Risk and Indemnity Form is a complete release of any responsibility or liability of the UNFCCC secretariat/United Nations for personal injuries and/or temporary or permanent disability or death and/or property loss damage sustained by the minor(s) on the United Nations premises while participating in the conference/meeting, and that the UNFCCC secretariat/United Nations shall not be liable or responsible for the minor(s) in any manner whatsoever.

Place, date and signature:

Annex: Details of minor(s)

Details of minor(s) (maximum of two minors per chaperon)

Full name:

Date of birth (age):

Resident of:

Relationship with the chaperon:

Full name:

Date of birth (age):

Resident of:

Relationship with the chaperon: