Overnight Stay Emergency Information/medical Release/liability Waiver Form (Page 2 of 2) in pdf

OVERNIGHT STAY

LIABILITY WAIVER FORM

NAME OF ACTIVITY: Scripps College Prospective Student Overnight Stay

NAME OF PARTICIPANT_________________________________________________

DATE OF BIRTH____________________

ADDRESS______________________________________________________________

CITY, STATE, ZIP_______________________________________________________

I am the parent/guardian of (participant name) ___________________________ (the “Participant”). I

acknowledge that I have voluntarily consented to allow the Participant to participate in the above-

referenced activity and I have full knowledge of the risks that this activity presents, including travel to,

participation in, and returning from the activity. I am aware that portions of this activity are not guided or

supervised by the College.

I as parent/guardian agree on behalf of the Participant to assume any and all risk of injury or death to the

Participant. I understand and agree that as a condition of participation in this activity, I as parent/guardian

of the Participant and on behalf of the Participant hereby release from liability and will indemnify,

Scripps College, its officers, trustees, agents, employees, assigns, successors, or lessors (the Scripps

Releasees”) for any damage, injury, or death to the Participant, or any other persons or property, that

results from any negligence, but not gross negligence, of any Scripps Releasee that is in any way

connected with the Participant’s participation in this activity.

I have carefully read this agreement and fully understand all of its terms and conditions. I understand that

this is a release of liability, which could legally prevent me and/or the Participant from filing a law suit or

making any other legal claim for damages in the event of the Participant’s death or injury. With this

knowledge, I, in my individual capacity and my capacity as parent/guardian of the Participant, am

entering into this agreement fully and voluntarily. I agree that the agreement is binding upon me, my

spouse, my heirs, my children including any guardian ad litem for the children, my assignees, and legal

representatives. I understand and agree that I am signing this waiver and release on behalf of my minor

child that I am giving up rights for the minor child.

_______________________________

________________________

Parent/Guardian’s Signature

Date

_______________________________

Parent/Guardian’s Printed Name

Overnight Stay Emergency Information/medical Release/liability Waiver Form Page 2