Waiver, Indemnification, And Medical Treatment Authorization Form printable pdf download

WAIVER, INDEMNIFICATION, AND MEDICAL TREATMENT

AUTHORIZATION FORM

1. EXCULPATORY CLAUSE. In consideration for receiving permission to participate in any and all

activities

______________________________

(“activity”),

which

sponsored

______________________________ (“sponsor”), a member of The Texas A&M University System, I hereby

release, waive, covenant not to sue, and agree to hold harmless for any and all purposes sponsor, The Texas

A&M University System, the Board of Regents for The Texas A&M University System, and their members,

officers, agents, volunteers, or employees (“RELEASEES” or “INDEMNITEES”) from any and all liabilities,

claims, demands, injuries (including death), or damages, including court costs and attorney’s fees and

expenses, that may be sustained by me while participating in this activity, while traveling to and from the

activity, or while on the premises owned, leased, or controlled by RELEASEES, including injuries sustained

as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict

liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly

negligent conduct.

2. INDEMNITY CLAUSE. I am fully aware that there are inherent risks to myself and others involved

with this activity, including but not limited to ____________________________________________________,

and I choose to voluntarily participate in this activity with full knowledge that the activity may be hazardous to

me and my property, and to the person and property of others. I acknowledge there may be physically

strenuous activities. I know of no medical reason why I should not participate. I agree to indemnify and

hold harmless INDEMNITEES from any and all liabilities, claims, demands, injuries (including death), or

damages, including court costs and attorney’s fees and expenses, which may occur to myself, other

participants, and third-persons as a result of my participation and conduct in this activity, including injuries

sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or

strict liability of INDEMNITEES.

3. NO INSURANCE. I understand that RELEASEES do not maintain any insurance policy covering

any circumstance arising from my participation in this activity or any event related to that participation. As

such, I am aware that I should review my personal insurance coverage. Sponsor does not carry general

liability insurance to cover claims arising from this activity so it seeks a waiver of claims as additional

consideration for the right to participate so sponsor, a governmental unit of the State of Texas, can (a) provide

the activity at the lowest possible cost to participants; and (b) provide access to a greater number of

participants by expending limited resources on program materials rather than on liability insurance.

4. BINDS HEIRS. It is my express intent that this agreement shall bind the members of my family

and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be

governed by the laws of the State of Texas.

MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, and WAIVER. I

understand RELEASEES cannot be expected to control all of the risks associated with this activity and

RELEASEES may need to respond to accidents and potential emergency situations. Therefore, I hereby give

my consent for any medical treatment that may be required, as determined by a medical professional at the

medical facility, during my participation in this activity with the understanding that the cost of any such

treatment will be my responsibility. I agree to indemnify and hold harmless INDEMNITEES for any costs

incurred to treat me, even if an INDEMNITEE has signed hospital documentation promising to pay for the

treatment due to my inability to sign the documentation. I further agree to release, waive, covenant not to sue,

and agree to hold harmless for any and all purposes, RELEASEES from any and all liabilities, claims,

demands, injuries (including death), or damages, including court costs and attorney’s fees and expenses, that

may be sustained by me while receiving medical care or in deciding to seek medical care, including while

traveling to and from a medical care facility, including injuries sustained as a result of the sole, joint, or

concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES.

understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct.

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Waiver, Indemnification, And Medical Treatment Authorization Form

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