Travel And Trip Risk Acknowledgement Liability Waiver Form printable pdf download

STETSON UNIVERSITY

TRAVEL and TRIP RISK ACKNOWLEDGEMENT/LIABILITY WAIVER FORM

– FOR STETSON FIELD TRIPS, OFF-CAMPUS FUNCTIONS OR COURSE RELATED TRIPS AND RECREATIONAL ACTIVITIES

Stetson University sponsors field trips and special events for students as a means of providing a comprehensive and diverse learning environment. Field

trip/event participants and leaders are expected to conduct themselves in a professional and positive manner as representatives of Stetson University. All

students must adhere to and are responsible for knowing the Student Code of Conduct as part of their enrollment at Stetson University. Failure to follow

operating guidelines, instructor/staff directives, and the Student Code of Conduct may result in disciplinary action. (Student Code of Conduct is now available

on the Stetson Intranet under the “Res Life” section / ‘Policies’/ `Code of Community Standards’).

TRAVEL: Trip Director and Dept:

Name of Field Trip, Course & Travel Dates: (Date (s)- Trip to : (Name of Venue/Bldg/Org) in (City, State); Course:

(“trip”)

Mode of Travel: ___ Self-Travel/Personal Vehicle ____Rental Vehicle

____ Commercial Bus/Shuttle

Special Activities/ Risks include but are not limited to: Vehicle Travel to ‘ City, State’; Foot Travel at location, Exposure to

unfamiliar city or large crowds, Exposure to weather or outdoors, etc

Precautions : Check weather before departure; Wear appropriate clothing for venue and proper footwear for walking/activities.

Additional Risks, Activities and Precautions including Overnight Stay: - Please see the attached as applicable!

This is to certify that _______________________________________ has full permission to, and/or has voluntarily agreed to:

(Student / Participant Name - Print)

Travel in a group or independently, off campus, within the United States, in connection with a field trip, function, event, or course of

Stetson University, Inc. (“university”).

II.

LIABILITY WAIVER / RISK ACKNOWLEDGEMENT:

I understand that participation in trip activities could involve risk of physical injury, illness, death or property loss, and despite safety

precautions, the university cannot guarantee safety thereof, as all risks cannot be prevented. Stetson University, does not provide health and

accident insurance for trip participants, and I understand that any medical expenses, property loss, or other personal expenditures that result

during or from this travel/trip, are to be borne by the student/participant, or by their parent or guardian (if student/participant is a minor). I also

hereby consent, give authorization to, and release from liability; trip leaders to secure any emergency medical treatment in event I am unable

to, and I agree to be responsible for the costs thereof.

I further acknowledge that if I drive my own vehicle, or am a passenger in another’s private vehicle in connection

with this trip/function, that Stetson University’s auto insurance does not cover such a private vehicle. I also understand that the University

cannot be responsible for assuring the safety and reliability of such private transportation or driver, nor for any

non-sponsored activities and travel that I/my child might choose to participate in before, during or after the university sponsored function, and I

therefore accept the risks and responsibilities associated with such private vehicle travel and activities.

In consideration of the opportunity afforded, with full knowledge and acceptance of the risks associated with this trip and any

recreational activities noted within; and with full understanding of the above issues/conditions and risks, I hereby release, indemnify

and hold harmless Stetson University, Inc, its faculty/staff, trustees, officers, volunteers, and agents from all form and manner of risks

inherent in, and from all claims, suits and demands of any nature arising from participation in said trip, or activities.

__________________________________________________________ __________

________________________________________________________________

Signature of Student/Participant

Date

Signature of Parent or Guardian

Date

(needed if student/participant is a minor – under 18 )

_____________________________________________________________

___________________________________________________________

Print Student/Participant Name

Print Parent/Guardian Name

_____________________________________________________________

___________________________________________________________

Signature of Witness for Student/Participant

Signature of Witness for Parent/Guardian

Emergency Contact Name:________________________________________ Phone:________________________________

(Rev- 1-14)

Travel And Trip Risk Acknowledgement Liability Waiver Form

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