Fillable Printable Accident Waiver and Release of Liability Template

Accident Waiver and Release of Liability Template

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM

Field Trip Title: ______ ___________________ __________________ Date of Departure: __________________

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS ACTIVITY, including by way of

example and not limitation, any risks that may arise from negligence or carelessnes s on the part of the persons or

entities being released, from dangerous or defective equipment or property owned, maintain ed, or controlled by

them, or because of their possible liability without fault.

I certify that I am physically fit, h ave sufficiently prepared or trained for participation in this activity, and have not

been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons

or problems which preclude my participation in this activity.

I acknowledge that this Accident Waiver and Release of Liability Fo rm will be used by the event holders, sponsors,

and organizers of the activity in which I may participate, and that it will govern my actions and responsibilities at

said activity.

In consideration of my app lication and permitting me to participate in this activity, I hereby take action for myself,

my executors, administrators, heirs, next of kin, successors, and assigns as follows:

(A) I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability

arising from the negligence or fault o f th e entities or persons released, for my death, disability, personal injury,

property damage, property theft, or actions of any kind which may hereafter occur to me including my traveling

to and from this activity, THE FOLLOWING ENTITIES OR PERSONS: Th e Ecological Society of America,

Inc., (ESA) and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity

holders, sponsors, and volunteers;

(B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentione d in

this paragraph from any and all liab ilities or claims made as a result of participation in this activity, whethe r

caused by the negligence of release or otherwise.

I acknowledge that ESA and their directors, offi cers, volu nteers, representat i v es, and agents are NOT responsible for

the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.

I acknowledge that this activity may involve a test of a person's physical and mental limits and carries with it the

potential for death, serious injury, and property loss. The risks include, but are not limited to, those caused by

terrain, facilities, temperature, weather, condition of participan ts, equipment, vehicular traffic, lack of hydration, and

actions of other people including, but not limited to, participants, volunteers, monitors, and/or producers of the

activity. These risks are not only inherent to participants, but are also present for volunteers.

I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident,

and/or illness during this activity.

I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film

likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.

The Accident Waiver and Release of Liability Form shall be construed broadly to prov ide a release and waiver to

the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM

AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN

FREE WILL.

________________________________ _______ ____ __________________________________ ______

Participant’s Signature Date Participant’s Name Age

(If under 18 years old, Parent or Guardian must also sign.) (Please print legibly.)