Waiver And Release Of Liability Form printable pdf download

Waiver and Release of Liability

BOARD OF TRUSTEES OF COMMUNITY-TECHNICAL COLLEGES

Three Rivers Community College

Service Learning Activity Waiver Form

Participant's name: ______________________________________________________

Please Print

In consideration of being permitted to participate in activities connected with Service Learning courses

(hereinafter called "the Activity") I, for myself, my heirs, personal representatives or assigns, do hereby

release, waive, discharge, and covenant not to sue Three Rivers Community College and/or the Board of

Trustees of Community Technical Colleges (hereafter called “the College”), their trustees, officers,

employees and agents and to indemnify them from liability for any and all claims resulting from personal

injury, accidents or illnesses (including death), and property damage or destruction arising from, but not

limited to, participation in the Activity.

_______________________________________________________________________

Signature of Parent/Guardian of Minor

Date

_______________________________________________________________________

Signature of Participant

Date

Participant’s Age (if minor) ________

I understand that participation in the Activity carries with it certain inherent risks that cannot be eliminated

regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the

risks range from 1) minor injuries such as scratches, bruises and sprains, 2) major injuries such as eye

injury or loss of sight, joint or back injuries, heart attacks and concussions, to 3) catastrophic injuries

including paralysis and death.

I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are

inherent in the Activity. I hereby assert that my participation is voluntary and that I knowingly assume all

such risks.

I also agree to indemnify and hold the College harmless from any and all claims, actions, suits, procedures,

costs, expenses, damages and liabilities, including attorney’s fees, brought as a result of my involvement in

the Activity and to reimburse them for any such expenses incurred.

I further expressly agree that the foregoing waiver and assumption of risk agreement is intended to be as

broad and inclusive as is permitted by the law of the State of Connecticut and that if any portion thereof is

held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Finally, I have read this waiver of liability, assumption of risk and indemnity agreement, fully understand

its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge

that I am signing the agreement freely and voluntarily, and intend it by my signature to be a complete and

unconditional release of all liability to the greatest extent allowed by law.

_________________________________________________________________________

Signature of Participant

Date

Participant's Age (if minor) _____

_________________________________________________________________________

Signature of Parent/Guardian of Minor

Date

If under the age of 18, please also complete reverse side of this form.

Waiver And Release Of Liability Form

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