Hold Harmless Form printable pdf download

Hold Harmless Form

Please read the ENTIRE Hold Harmless on the back of this form

Name of Student __________________________________Course/Block_________________________

Date(s) of Absence _____________________________________________________________________

Event _______________________________________________________________________________

Plan of action: (faculty member will fill in what is expected of the student, including due dates):

Signature of Faculty Member of Course: ____________________________

Date______________

Signature of Student: ____________________________________________

Date ______________

Signature of Coach/ Club Advisor: __________________________________

Date _______________

Signature of Academic Advisor: __________________________________

Date _______________

This form MUST be filled out and fully executed on or before the first day of course

A copy of this signed form should be kept by the Faculty Member, Student, Coach/Club Advisor,

and Faculty Advisor

Hold Harmless Form