Contents of this page:
A. Informed
Consent and Assumption of Risk Form
B. To download a copy of the Informed Consent and
Assumption of Risk Form
C. Student/Participant Release and Indemnity Agreement
D. To download a copy of the Student/Participant
Release and Indemnity Agreement
TRINITY UNIVERSITY
INFORMED CONSENT AND ASSUMPTION OF RISK
Trinity University
is a non-profit educational institution. References to Trinity University
include
“TU”, its trustees,
officers, officials, employees, volunteers, students, agents, and assigns.
-
I (print your
name)_____________________________________ understand I am to
participate in the_____________________________________________
(henceforth referred to as the Program).
-
I fully understand and appreciate the dangers,
hazards and risks inherent in participating in the Program, in the
transportation to and from the Program, and in any independent research
or activities I undertake as an adjunct to the Program.
-
I agree that participating in any activity is an
acceptance of some risk of injury and/or loss or damage of property. I
agree that my safety is primarily dependent upon my taking proper care
of myself. I understand that is my responsibility to know what I will
need for the Program and to provide what I will need. I agree to make
sure that I know how to safely participate in any activities, and I
agree to observe any rules and practices, which may be employed to
minimize the risk of injury. I agree to stop and seek assistance if I do
not believe I can safely continue any activity. I will not wear or use
or do any thing that would pose a hazard to myself, or others, including
using or ingesting any substance which could pose a hazard to myself or
others. I agree that if I do not act in accordance with this agreement,
I may not be permitted to continue to participate in the Program.
In consideration of my
participation in this Program, I agree as follows:
SPECIFIC HAZARDS OF TRAVEL
OR PROGRAM:
Despite
precautions, accidents and injuries can occur. I understand that traveling,
doing fieldwork or being in a large city may be potentially dangerous, and
that I may be injured and/or lose or damage personal property as a result of
participation in the Program. Therefore, I ASSUME ALL RISKS RELATED TO
THE ACTIVITIES including, but not limited to:
-
Death, injury or illness from accidents of any
nature whatsoever, including, but not limited to, bodily injury of any
nature, whether severe or not, which may occur as a result of
participating in an activity or contact with physical surroundings or
other persons; arising from travel by car, bus or any other means;
death, injury or illness including food poisoning arising from the
provision of food or beverage by restaurants or other service providers.
-
Theft, loss or damage of my personal property
while in transit or participating in the Program.
-
Natural disaster or other disturbances, and
alteration or cancellation of the Program due to such causes.
-
Most trips to hospitals, schools and community
service centers require travel through or parking in high crime areas.
Please review the attached safety guidelines.
-
Listed below are specific dangers endemic in
this Program’s area of travel or endemic to the Program.
INSTITUTIONAL
ARRANGEMENTS:
I understand
that TU is not an agent of, and has no responsibility for, any third party
which may provide any services including food, lodging, travel, or other
goods or services associated with the Program. I understand that TU may
provide these services only as a convenience to participants and that
accordingly, TU accepts no responsibility, in whole or in part, for delays,
loss, damage or injury to persons or property whatsoever, caused to me or
others prior to departure, while traveling or while staying in designated
lodging. I further understand that TU is not responsible for matters that
are beyond its control. I acknowledge that TU reserves the right to cancel
the trip without penalty or to make any modifications to the itinerary
and/or academic program as deemed necessary by TU.
INDEPENDENT ACTIVITY:
I understand
that TU is not responsible for any loss or damage I may suffer when I am
traveling independently or I am otherwise separated or absent from any TU
activity. In addition, I understand that any travel that I do independently
on my own before or after the TU sponsored Program is entirely at my own
expense and risk.
HEALTH AND SAFETY:
I have been
advised to consult with a medical doctor with regard to my personal medical
needs. I state that there are no health-related reasons or problems that
preclude or restrict my participation in this Program. I have obtained the
required immunizations, if any. I recognize that TU is not obligated to
attend to any of my medical or medication needs, and I assume all risk and
responsibility. I agree to pay all expenses relating thereto.
TU RULES, REGULATIONS
AND POLICIES:
I agree to obey and comply at all times with all of the rules,
regulations, codes and policies of TU while participating in the Program. I
agree to notify my professor immediately of any injury or loss.
TRAVEL CHANGES:
If I become
separated from the Program group, fail to meet a departure airplane, bus, or
train, or become sick or injured, I will, to a reasonable extent, and at my
own expense seek out, contact, and reach the Program group at its next
available destination.
SIGNATURE:
I indicate that
by my signature below that I have read the terms and conditions of
participation and agree to abide by them. I have carefully read this
Informed Consent and Assumption of Risk Form and acknowledge that I
understand it. My signature below indicates that I have read and freely
signed this agreement, which take effect as a sealed instrument.
IMPORTANT – READ ENTIRE
AGREEMENT BEFORE SIGNING.
__________________________________ ___________________________
Signature of Program
Participant Date
__________________________________ ___________________________
Signature of Parent or
Legal Guardian Date
(If student is a
minor)
BY
SIGNING THIS DOCUMENT, YOU ARE WAIVING CERTAIN LEGAL RIGHTS.
PLEASE
READ THIS DOCUMENT CAREFULLY BEFORE SIGNING.
TRINITY
UNIVERSITY
STUDENT/PARTICIPANT
RELEASE AND INDEMNITY AGREEMENT
Printed
Name of Student/Participant:________________________________________
Course/Activity:________________________ Course Number (if
applicable):________
Instructor/Sponsor:______________________ Destination (if travel
required):________
Semester/Dates of Participation:___________________________________________
For and in consideration of being permitted to participate in the
Course/Activity above (including related travel, if any), I, THE
UNDERSIGNED, HEREBY FULLY RELEASE AND FOREVER DISCHARGE Trinity
University and all instructors, sponsors, agents, employees, officers,
trustees and affiliates of Trinity University (collectively “TU”), of and
from any and all liability to me, my personal representatives, assigns, heirs
and next of kin, for any damage to or loss of my property, any injury to my
person or my death or any one or more of the foregoing, arising directly or
indirectly out of my participation for any purpose in the Course/Activity, INCLUDING
ANY SUCH DAMAGE, LOSS OR INJURY THAT IS CAUSED BY ANY ACT OR OMISSION ON THE
PART OF TU, INCLUDING ANY NEGLIGENT CONDUCT OF TU but excluding any gross
negligence or willful misconduct of TU. IT IS MY EXPRESS INTENT THAT THE
ABOVE RELEASE INCLUDES THE RELEASE BY ME OF TU FROM THE CONSEQUENCES OF TU's
OWN NEGLIGENCE. THE ONLY CIRCUMSTANCE UNDER WHICH MY RELEASE OF TU DOES NOT
APPLY IS WITH RESPECT TO ANY OCCURRENCE RESULTING FROM THE GROSS NEGLIGENCE OR
WILLFUL MISCONDUCT OF TU. I
FURTHER AGREE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS TU for, from, and
against any and all liabilities, damages, claims, lawsuits, costs (including
court costs, attorneys fees and costs of investigation), and actions of any
kind or description for any damage to or loss of my property or the property
of another, any injury to me or my death, or the injury to or death of any
other person or any one or more of the foregoing, arising out of my
participation for any purpose in the Course/Activity, INCLUDING ANY DAMAGE,
LOSS OR INJURY CAUSED BY ANY ACT OR OMISSION ON THE PART OF TU, INCLUDING ANY
NEGLIGENT CONDUCT OF TU but excluding any gross negligence or willful
misconduct of TU. IT IS MY EXPRESS INTENT THAT THE ABOVE INDEMNITY INCLUDES
INDEMNIFICATION BY ME OF TU FROM THE CONSEQUENCES OF TU's OWN NEGLIGENCE. THE
ONLY CIRCUMSTANCE UNDER
WHICH
MY OBLIGATION TO INDEMNIFY TU DOES NOT APPLY IS WITH RESPECT TO AN OCCURRENCE
RESULTING FROM THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF TU.
By execution below I hereby acknowledge that I recognize and
assume all of the risks associated with the Course/Activity. I ACKNOWLEDGE
THAT IT IS IMPORTANT THAT I VERIFY THAT I HAVE INSURANCE COVERAGE WHICH
EXTENDS TO ME WHILE PARTICIPATING IN THE COURSE/ACTIVITY, AND THAT I SECURE
SUCH COVERAGE IF I DO NOT ALREADY HAVE IT. I understand that TU
does not provide such coverage, and that no insurance coverage may exist
through TU to cover any injuries or damages which I may sustain or claims
which may arise as a result of my participation in the Course/Activity.
The terms of this Release
and Indemnity Agreement are to be governed by and construed under the laws of
the State of Texas, and venue with respect to any dispute arising between TU
and any other party that involves this Release and Indemnity Agreement or my
participation in the Course/Activity shall be exclusively in Bexar County,
Texas. Each provision of this
Release and Indemnity Agreement is severable and if one portion is invalid or
illegal, such invalid or illegal portion shall not apply, but the remaining
portions shall nevertheless remain in full force and effect. I understand that
the terms of the Release and Indemnity Agreement are contractual and not mere
recitals, and that such terms are binding upon me, my heirs, personal
representatives and
assigns. In making this Release
and Indemnity Agreement, I have not relied upon any statement or
representation pertaining to this matter made by TU or any other person or
entity which is hereby released. I
WARRANT THAT I HAVE CAREFULLY READ THIS DOCUMENT AND KNOW ITS CONTENTS, AND
THAT I AM 18 YEARS OF AGE OR OLDER AND HAVE FULL AUTHORITY TO EXECUTE THIS
DOCUMENT AND THAT I HAVE EXECUTED THIS DOCUMENT VOLUNTARILY AND AS MY OWN FREE
ACT. I EXECUTE THIS DOCUMENT FULLY INTENDING TO BE BOUND BY ITS TERMS.
Dated this _______ day of ___________________, 2_____.
____________________________________________
Signature
of Student/Participant
If the Student/Participant is not eighteen (18) years of age or older, the
signature of Student/Participant's parent or legal guardian is required.
As parent or legal guardian of the above-mentioned Student/Participant, I
agree to and approve the terms of this Release and Indemnity Agreement and
consent to the Student/Participant's
participation
in the Course/Activity and warrant that I have full authority to do so on
behalf of myself, the Student/Participant and the Student/Participant's heirs,
personal representatives and assigns. I understand and assume the risks of the
Student/Participant's participation in the Course/Activity.
I, THE
UNDERSIGNED, HEREBY FULLY RELEASE AND FOREVER DISCHARGE
Trinity University and all instructors, sponsors,
agents, employees, officers, trustees and affiliates of Trinity University
(collectively "TU"), of and from any and all liability to me, my
personal representatives, assigns, heirs and next of kin, from any and all
claims, demands, controversies, actions or causes of action, belonging to me
or Student/Participant now or in the future for any damage to or loss of
Student/Participant's property, and any injury to Student/Participant's person
or Student/Participant's death or any one or more of the foregoing, arising
directly or indirectly out of Student/Participant's participation for any
purpose in the Course/Activity, INCLUDING ANY DAMAGE, LOSS OR INJURY CAUSED
BY ANY ACT OR OMISSION ON THE PART OF TU, INCLUDING ANY NEGLIGENT CONDUCT OF
TU but excluding any gross negligence or willful misconduct of TU. IT
IS MY EXPRESS INTENT THAT THE ABOVE RELEASE INCLUDES THE RELEASE BY ME OF TU
FROM THE CONSEQUENCES OF TU's OWN NEGLIGENCE. THE ONLY CIRCUMSTANCE UNDER
WHICH MY RELEASE OF TU DOES NOT APPLY IS WITH RESPECT TO ANY OCCURRENCE
RESULTING FROM THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF TU.
I FURTHER AGREE TO
INDEMNIFY, DEFEND, AND HOLD HARMLESS
TU for, from and against any and all liabilities,
damages, claims, lawsuits, costs (including court costs, attorneys fees and
costs of investigation), and actions of any kind or description for any damage
to or loss of Student/Participant's property or the property of another, any
injury to Student/Participant or any other person, any injury resulting in
Student/Participant's death or the death of another or any one or more of the
foregoing, arising out of Student/Participant's participation for any purpose
in the Course/Activity, INCLUDING ANY DAMAGE, LOSS OR INJURY CAUSED BY ANY
ACT OR OMISSION ON THE PART OF TU, INCLUDING ANY NEGLIGENT CONDUCT OF TU but
excluding any gross negligence or willful misconduct of TU. IT IS MY
EXPRESS INTENT THAT THE ABOVE INDEMNITY INCLUDES INDEMNIFICATION BY ME OF TU
FROM THE CONSEQUENCES OF TU's OWN NEGLIGENCE. THE ONLY CIRCUMSTANCE UNDER
WHICH MY OBLIGATION TO INDEMNIFY TU DOES NOT APPLY IS WITH RESPECT TO AN
OCCURRENCE RESULTING FROM THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF TU.
Dated this
_________ day of ____________________, 2____.
_________________________________________________
Signature
of Parent or Legal Guardian
_________________________________________________
Printed
Name of Parent or Legal Guardian
Revised 8/13/04
Where to get the
forms:
| Request in person at: |
NH/410 |
| Request by interoffice mail to: |
Fiscal Affairs |
| Request by phone at: |
(210) 999-7306 |
OR:
Click
here to open and print the form "Informed
Consent and Assumption of Risk Agreement"
(Use with credit course field
trips, internships and practica)
Click
here to open and print the form "Student/Participant
Release
and Indemnity Agreement",
with participant under 18 years of age attachment for parent or
guardian.
(Use for student participation in those activities that are voluntary or do
not involve for-credit course)
Adobe Acrobat Reader is needed
to open and print the form.
If you do not have this free
software, you can download it.
Click
here to download Adobe
Acrobat Reader
Where to submit the forms:
This form should be kept in the
files of the respective department, or may be submitted to the Office of
Fiscal Affairs.
| Submit in person at: |
NH/410 |
| Submit by interoffice mail to: |
Fiscal Affairs |
| Submit by fax to: |
(210) 999-7062 |
