ࡱ> /1.y Hbjbj .{{H 66666JJJJ^J0rrrrrMMM[]]]]]]$ 6MMMMM66rrM6r6r[M[rDkYcG0`y``6XMMMMMMM7MMMMMMM`MMMMMMMMM : RELEASE AND IDEMNIFICATION WHEREAS I wish to participate in a field trip to ____________________________ (hereinafter referred to as the Destination) as part of the _____________ course on _________________, 20 __ , as well as any activities offered therein (all of which activities are hereinafter collectively referred to as the Field Trip); IN CONSIDERATION of the University of 91ȫܰ arranging for me to have the opportunity to participate in the Field Trip in a location off campus from the University and beyond the control of the University, more specifically at the Destination: 1. I acknowledge that there are potential risks associated with participating in the Field Trip, including, but not limited to: (a) Plant, insect and animal allergens; (b) Weather-related risks such as sunstroke, sunburn, hypothermia; (c) Water-related risks such as drowning or illness from water consumption; (d) Food-related risks such as allergic reactions, illnesses or infections from food (e) Viral and bacterial diseases such as West Nile Virus, Hantavirus Pulmonary Syndrome or Lyme Disease; (f) Bodily-injury risks such as external or internal bodily injuries; (g) Personal safety risks such as being mugged, robbed, or sexually assaulted; (h) Miscellaneous risks such as errant gunfire from hunting activities or wildfire. 2. I agree to participate in the Field Trip notwithstanding all potential risks and further agree to assume all related risks of attending at and participating in the Field Trip. 3. I, on my own behalf and on behalf of my heirs, executors, administrators and assigns release the University, its respective servants, agents or employees (all of whom are collectively referred to as the University) from any liabilities, claims or actions of any nature whatsoever arising from or related to any and all personal injury (including death), loss or damages to property howsoever arising, including personal injury, death, loss or damages to property resulting from the negligence of the University while I am attending at, participating in or travelling to or from the Field Trip. Such negligence of the University may include, without limitation, failure to implement adequate safety procedures or to provide adequate safety equipment. 4. I further agree to indemnify the University, its servants, agents or employees from any damages which may result or any and all claims or demands which may be made against the University howsoever arising out of the consequence of my attendance at, participation in or travel to and from the Field Trip. 5. I further state that I am of lawful age and legally competent to sign this Release and Indemnification. In signing this Release and Indemnification, I am not relying upon any oral or written representations or statements made by the University other than what is set forth in the Release and Indemnification. I have read and understood this Release and Indemnification, and I am aware that by signing this Release and Indemnification I am waiving certain legal rights which I or my heirs, next of kin, executors, administrators, and assigns may have against the University. ___________________________________ ________________________________ Witness Signature ___________________________________ ________________________________ Your Name Your Signature Date: ______________________________ ,Vhi L [ \ + A E R U ` h w K 9 < G R jq{~BI~;JSTUWȶѶȶѶȶѶѶѶhh'+^Jhh+^Jhhb ^Jhhi^Jhh%%N^Jhh6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ OJPJQJ_HmH nH sH tH J`J Normal dCJ_HaJmH sH tH DA D Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List H`H '+ No SpacingCJ_HaJmH sH tH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] H WH H 8@0(  B S  ?txJ CJJ 3TUuw;<  ~  U W z   # ( G J TUuw;<  ~  U W z   # ( G J b ?$)'+%%Nibvn