Passenger Waiver

OCCIDENTALCOLLEGE

Passenger Waiver

This waiver form is to be signed by all passengers in personal vehicles or Occidental vehicles used for College approved activities. All drivers of personal vehicles for College approved activities must be Designated Drivers. Please submit this form, signed by all passengers, before leaving campus by depositing the form in the mail slot at Campus Safety or the mail box on the Campus Safety/Facilities yard gate. (If you need assistance, call Campus Safety from the yellow call box at the gate or ext. 2599.) [This blank form may be copied if you need more waiver forms.]

EVENT NAME:______DEPARTMENT ______

DESTINATION:______

DATE & TIME OF DEPARTURE/RETURN:______/______

Liability, Risk Acknowledgment, and Claims Release Form

I, the undersigned, wish to be transported as a passenger in a privately owned automobile driven by ______in order to participate in ______(herein “Event”), an event or program sponsored or approved by OccidentalCollege (herein “Occidental”). I realize that there are inherent risks involved in riding as a passenger in an automobile, including the possibility of serious physical injury, other injuries or accidents or even death. In consideration for receiving permission to participate in this “Event”, I knowingly and freely agree to accept these risks as a condition of my participation. I agree for myself, my heirs, administrators, executor and employees to hereby release, hold harmless, and indemnify, including cost of defense, “Occidental,” its officers, trustees, employees, agents and related parties, from any and all liability for any loss, injury, or damage, including without limitation, any claim for personal injuries resulting from or arising out of the negligence of “Occidental” in connection with my transportation in a privately owned vehicle as part of my participation in the “Event”. I acknowledge that I sign this Liability, Risk Acknowledgment and Claims Release Form with full knowledge of California Civil Code Section 1542 which reads:

“A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.”

The provisions of this statute are hereby waived. I have carefully read this Liability, Risk Acknowledgment and Claims Release Form and know and understand its contents. I understand it is a full release of all liability and I sign it of my own free will. I, the undersigned, also understand that I must sign this agreement before riding as a passenger in a privately owned vehicle as part of my participation in the “Event” described above. Dated this ______day of ______, 200__.

SignaturePrinted Name

8/23/07