Release of Liability, Waiver and Assumption of Risk Agreement

Road Test Candidate

BY SIGNING THIS DOCUMENT (in pen or digitally), YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING
THE RIGHT TO SUE OR CLAIM COMPENSATION. PLEASE READ CAREFULLY!

WHEREAS in response to the COVID-19 PANDEMIC and the corresponding PUBLIC HEALTH ORDERS OF THE
GOVERNMENT OF SASKATCHEWAN (the “Public Health Orders”), Saskatchewan Government Insurance (“SGI”) has
suspended road tests;

WHEREAS SGI will authorize road tests (the “Test”) on a case-by-case basis;

WHEREAS the method of conducting Tests has been modified as follows: a vehicle operated by an SGI driver examiner
(the “Examiner”) will follow the Test candidate’s (the “Driver”) vehicle; a Test supervisor selected by the Driver (the
“Supervisor”) will occupy the Driver’s vehicle during the Test; the Driver’s vehicle will be equipped with an SGI owned
dashcam (the “Dashcam”) for the purpose of recording the Test; the Examiner will communicate directions to the Driver via
electronic communications equipment (cellular phone equipped with Bluetooth or speaker mode) (the “ECE”); and both the
Examiner and the Driver will activate and connect their ECE before the Test begins (collectively referred to as the “Safety
Measures”).

WHEREAS, there is presently an exemption in place allowing new drivers to utilize ECE during the Test and this exemption
is valid for the period April 1, 2020 to May 30, 2020, unless otherwise amended;

THEREFORE, in consideration of SGI authorizing my participation in a Test, I, _____________________________________

of _____________________________________ , Saskatchewan and my successors and assigns, do hereby acknowledge
and agree TO RELEASE SGI, its members, officers, directors, employees, subsidiaries, and agents FROM ALL
LIABILITY, and do hereby WAIVE AS AGAINST SGI, its members, officers, directors, employees, subsidiaries,
and agents, ALL RECOURSE, CLAIMS, LEGAL PROCEEDINGS, OR CAUSES OF ACTION OF ANY KIND
WHATSOEVER, in respect of all loss, damages, personal injuries or death which I may suffer arising out of, or connected
with, MY EXPOSURE TO COVID-19 as a result of participating in the Test, notwithstanding that such injuries or losses
may have been caused solely or partly by the negligence of SGI or any of its employees, officers, directors, or agents.

AND, I DO HEREBY FURTHER ACKNOWLEDGE AND AGREE THAT:

a) SGI has suspended all road tests as a result of the COVID-19 pandemic and the corresponding public health
orders. I understand the health risks associated with exposure to COVID-19, including hospitalization and death.
Nevertheless, I have freely and voluntarily chosen to apply to SGI for authorization to participate in the Test, and I freely and
voluntarily chose to participate in the Test;

b) Despite the Safety Measures, there is risk to my personal health and safety associated with my participation in the Test.
Some of these risks are inherent and some may result from human error or negligence. Some of the risks are foreseeable,
but some are not. I, as a participant in the Test, may contract COVID-19;

c) SGI has no knowledge of my personal health history, status or conditions. I have honestly answered all health screening
questions asked by SGI;

www.sgi.sk.ca
d) If required by SGI, I will install the Dashcam in the vehicle that I operate during the Test. The Test will be recorded with the
Dashcam, and I consent to the collection, use and disclosure of the Dashcam recording for the purpose of the Test. I accept
all risks associated with the installation and use of the Dashcam, including exposure to COVID-19;

e) I selected a Supervisor of my own choice, and I accept all risks associated with that Supervisor accompanying me during
the Test, including exposure to COVID 19;

f) Aside from SGI’s statutory obligation as the administrator of injury benefits under The Automobile Accident Insurance Act,
neither SGI nor any of its members, officers, directors, employees, subsidiaries, or agents assume any responsibility
whatsoever for damage to my personal health, safety or security as a result of SGI’s authorization of the Test or my
participation in the Test;

g) My exposure to or contraction of COVID-19 or any complications that arise as a result of my contraction of COVID-19 do
not constitute an “accident” within the meaning of The Automobile Accident Insurance Act;

h) I, nevertheless, freely and voluntarily assume all risks associated with the Test and my potential exposure to COVID-19, and
accordingly, my participation in the Test shall be entirely at my own risk;

i) I understand that this Release of Liability, Waiver and Assumption of Risk Agreement (the “Release of Liability Agreement”)
applies to all Tests I take while the suspension of normal road testing is in place, and the terms of this Release of Liability
Agreement need not be brought to my attention each time I participate in a Test in order for it to be effective;

j) I was given the opportunity to seek independent legal advice prior to signing this Release of Liability Agreement. I had
enough time to read this Release of Liability Agreement and to ask questions prior to signing it. I have read, and I fully
understand and accept the terms of this Release of Liability Agreement in its entirety; and

k) If any part of this Release of Liability Agreement is found to be invalid or unenforceable, that finding will not affect the validity
or enforceability of any other part of this Release of Liability Agreement.

Printed name (driver)

Signature Date

Printed name (witness)

Signature Date

Where Driver is 18 years of age or younger:

Printed name (parent/guardian)

Signature Date

Submit