Viterbo University - The University of Opportunity: Hope and Help

Off-campus Activity Waiver and Release of Liability Form

This form is to be completed prior to off-campus trips and activities.

 

I, (Name)   and my heirs, in consideration of my participation in the activity of
(Name of trip)   from
(Start date and time to end date and time)  hereby release the Board of Trustees of Viterbo University, its officers, employees, and agents, from any liability for damage to, or loss of personal property, sickness, and injury from whatever source, legal entanglements, imprisonment, death, loss of money, etc., which might occur while participating in any service trip activities.

I understand the risk of participation in this activity, which is coordinated by
(Name of hosting organization, class, etc.)   which include motor vehicle accidents, injury resulting from the use of tools and equipment, and illness and injury resulting from weather conditions to name but a few.

  • I agree to abide by posted safety rules, adhere to the wearing of appropriate clothing and safety equipment, and to conduct myself in a safe and responsible manner.
  • I attest and verify that I am physically fit to participate in these activities.
  • I further understand that the university provides no medical coverage for these activities. Should I incur medical expense, I understand that I am solely responsible for such costs.
  • I understand that participation is voluntary and I freely choose to participate.

 

Online signature

Signature of parent/legal guardian, if participant is under 18 years of age.