For Field Trips and Other Off-Campus Activities

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GADSDENSTATECOMMUNITYCOLLEGE

AGREEMENTFORRELEASEOFLIABILITY,ASSUMPTIONOFRISKANDINDEMNIFICATION

(For Field Trips and Other Off-Campus Activities)

Inconsiderationofbeingallowedtoparticipateinprogram-relatedeventsandactivitiessponsoredfororbyGadsdenState,Itheundersigned,acknowledge,appreciate,andagreeasfollows:

1.IherebyRELEASE,WAIVE,DISCHARGE,andCOVENANTNOTTO SUE,GadsdenStateCommunityCollege,itsofficers,servants,agents,oremployeesfrom any and all liability, claims, demands, actions, and causes ofactionwhatsoeverarisingoutorrelatedtoanyloss,damage,orinjury,thatmaybesustainedbyme,ortoanypropertybelongingtome,WHETHERCAUSEDBYTHENEGLIGENCEOFGADSDENSTATECOMMUNITYCOLLEGE,orotherwise,whileparticipatinginsuchactivity,orwhilein,on,oruponthepremiseswheretheactivityisbeingconductedorintransportationtoandfromsaidpremises.

2.Tothebestofmyknowledge,IcanfullyparticipateinthisactivityandamfullyawareoftherisksandhazardsconnectedwiththeactivityandIherebyelecttovoluntarilyparticipateinsaidactivityandengageinsuchactivityknowingthattheactivitymaybehazardoustomeandmyproperty.IVOLUNTARILYASSUMEFULLRESPONSIBILITYFORANY RISKSOFLOSS,PROPERTYDAMAGEORPERSONALINJURY,thatmaybesustainedbyme,oranylossordamagetopropertyownedbyme,as a resultofbeingengagedinsuchanactivity,

3.ItismyexpressintentthatthisAgreementshallbindthemembersofmyfamily,myheirs,assignsandpersonalrepresentative,andshallbedeemedasaRELEASE,WAIVER,DISCHARGE,andCOVENANTNOTTOSUEGadsdenStateCommunityCollege.

4.IUNDERSTANDTHATGADSDENSTATECOMMUNITYCOLLEGEWILLNOTBERESPONSIBLEFORANYMEDICALCOSTSASSOCIATEDWITHANINJURYTHATIMAYSUSTAIN.IRELEASEANDHOLDHARMLESSITSAGENTS,AFFILIATES,OFFICERSANDEMPLOYEESFROMALLMEDICALCOSTSANDMEDICALEXPENSES ASSOCIATED WITH THIS ACTIVITY.

IhavereadthisAgreementforReleaseofLiability,fullyunderstanditsterms,understandthatIhavegivenupsubstantialrightsbysigningitandsignitfreelyandvoluntarilywithoutanyinducement.InexecutingthisreleaseIassertthatIam18yearsofageorolderandmakethisdecisioninformedofitsimplicationsandentirelyofmyownfreewill.

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PARTICIPANT(print)

G NUMBER

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PARTICIPANTSIGNATURE

DATE

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_____ DATE OF BIRTHAGE

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EMERGENCY CONTACT NAME

EMERGENCY PHONE NUMBER

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FORPARENT/GUARDIANSOFPARTICIPANTSUNDERAGE18

ThisistocertifythatI,asparent/guardianwithlegalresponsibilityforthisparticipant,doconsentandagreetoalloftheprovisionsoftheAGREEMENTFORRELEASEOFLIABILITY,ASSUMPTIONOFRISKANDINDEMNIFICATION,andfor

myself,myheirs,assigns,andnextofkin,IreleaseandagreetoindemnifyandholdharmlessGadsdenStateCommunityCollegefromanyandallliabilitiesrelatedtomyminorchild’sparticipationintheprogram,relatedeventsandactivities,evenifarisingfromthenegligenceofGadsdenStateCommunityCollege.

PARENT/GUARDIAN (print)DATE

PARENT/GUARDIANSIGNATURE