Release Of Liability Form

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RELEASE OF LIABILITY FORM
RELEASE OF LIABILITY, WAIVER OF RIGHT TO SUE, ASSUMPTION OF RISK AND AGREEMENT
TO PAY CLAIMS
Short Description of Internship Activity. (Complete internship description must be included at the
end of this form.):
Internship Date(s) and Time(s): _________________________________________________________
Internship Location/Facility: ___________________________________________________________
Hazards to be aware of: ______________________________________________________________
Hazard mitigation (how to prepare for the internship): ______________________________________
In consideration for being allowed to participate in this Activity, I release from liability and waive my right
to sue the State of California, the Trustees of the California State University, which own and operate
California State University, Sacramento and their employees, officers, volunteers and agents (collectively
“University”) from any and all claims, including the University’s negligence, resulting in any physical injury,
illness (including death) or economic loss that I may suffer because of my participation in this Activity,
including any travel to and from the Activity.
I am voluntarily participating in this Activity. I understand that there are risks, such as physical and/or
psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability or even
death, which may occur from my participation in this Activity. These injuries or outcomes may arise from
my own or other’s actions, inactions, negligence, or from the condition of the Activity location(s) or
facility(ies). Nonetheless, I assume all related risks, whether known or unknown to me, of my
participation in this activity, including travel to and from the Activity.
I agree to hold the University harmless from any and all claims, loss or damage to my personal property,
liabilities and costs, including attorney’s fees, as a result of my participation in this Activity, including travel
to and from the Activity. If the University incurs any of these types of expenses, I agree to reimburse the
University.
If I need medical treatment, the University is authorized to obtain medical treatment for me. I will be
financially responsible for any costs of such treatment. I agree that I will not hold the University
responsible for any claims resulting from any medical treatment. I am aware that the University does not
provide health insurance for me and I should carry my own health insurance.
I am 18 years or older. I have read this document, and I am signing it freely. I understand the legal
consequences of signing this document, including (a) releasing the University from all liability, (b) waiver
of my right to sue the University, (c) and assumption of all risks of participating in this Activity, including
travel to and from the Activity.
I understand that this document is written to be as broad and inclusive as legally permitted by the State of
California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the
remaining terms.
Participant Name:____________________________________ Date: ________________
Signature: _______________________________________________________________

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