Hold Harmless Form printable pdf download

University of California, Riverside

HOLD HARMLESS AGREEMENT FORM

This form is required by the University when any facility on campus is scheduled involving an off-campus individual speak-

ing or performing at your event. Please fill out the below information and have the off-campus individual sign and date the

form and return it to the Non-Academic Scheduling Office at:

UCR Student Commons

Non-Academic Scheduling Office

200 Commons

Riverside, CA 92521

FAX: 951-827-2393

Please contact the Non-Academic Scheduling Office at 951-827-3215 if you have any questions regarding the below form.

In consideration for permission to provide _____________________ as part of the ________________________________,

(Type of Service)

(Event Title)

sponsored by ____________________________________ being held on the University of California, Riverside campus on

(Student Organization Booking Event)

________________________, 20______, _________________________________________________________ agrees to

(Month and Day)

(Year)

(Speaker/Performer’s Name)

indemnify, hold harmless, defend, release, and forever discharge The Regents of the University of California

(“University”), its officers, agents, employees, and any person or persons under its direction and control from, and waive

any and all responsibility of same, for any and all liability, claims, demands, actions, loss or expense (including costs and

attorneys’ fees), loss or damage of any kind whatsoever imposed by law upon the University for damages because of bodily

injury, including death at any time resulting therefrom, sustained by any person or persons, or on account of damages to

property, including loss of use thereof, arising out of or in consequence of the performance of this agreement, provided such

injury to persons or damage to property results from and is caused by the negligent or willful acts or omissions of

_________________________________________, its officers, agents, employees, or any person or persons under its direct

(Speaker/Performer’s Name)

supervision and control.

__________________________________

Speaker/Performer’s Signature

__________________________________

Print Speaker/Performer’s Name

__________________________________

Speaker/Performer’s Mailing Address

__________________________________

Speaker/Performer’s Phone Number

_______________________________

Date

Revised 11/05

Hold Harmless Form