Fillable Printable General Release of Liability Form

General Release of Liability Form

RELEASE OF LIABILITY FORM

RELEASE OF LIABILITY, WAIVER OF RIGHT TO SUE, ASSUMPTION OF RISK AND AGREEMENT

TO PAY CLAIMS

Short Description of Internship Activity. (Complete internship description must be included at the

end of this form.):

Internship Date(s) and Time(s): _________________________________________________________

Internship Location/Facility: ___________________________________________________________

Hazards to be aware of: ______________________________________________________________

Hazard mitigation (how to prepare for the internship): ______________________________________

In consideration for being allowed to participate in this Activity, I release from liability and waive my right

to sue the State of California, the Trustees of the California State University, which own and operate

California State University, Sacramento and their employees, officers, volunteers and agents (collectively

“University”) from any and all claims, including the University’s negligence, resulting in any physical injury,

illness (including death) or economic loss that I may suffer because of my participation in this Activity,

including any travel to and from the Activity.

I am voluntarily participating in this Activity. I understand that there are risks, such as physical and/or

psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability or even

death, which may occur from my participation in this Activity. These injuries or outcomes may arise from

my own or other’s actions, inactions, negligence, or from the condition of the Activity location(s) or

facility(ies). Nonetheless, I assume all related risks, whether known or unknown to me, of my

participation in this activity, including travel to and from the Activity.

I agree to hold the University harmless from any and all claims, loss or damage to my personal property,

liabilities and costs, including attorney’s fees, as a result of my participation in this Activity, including travel

to and from the Activity. If the University incurs any of these types of expenses, I agree to reimburse the

University.

If I need medical treatment, the University is authorized to obtain medical treatment for me. I will be

financially responsible for any costs of such treatment. I agree that I will not hold the University

responsible for any claims resulting from any medical treatment. I am aware that the University does not

provide health insurance for me and I should carry my own health insurance.

I am 18 years or older. I have read this document, and I am signing it freely. I understand the legal

consequences of signing this document, including (a) releasing the University from all liability, (b) waiver

of my right to sue the University, (c) and assumption of all risks of participating in this Activity, including

travel to and from the Activity.

I understand that this document is written to be as broad and inclusive as legally permitted by the State of

California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the

remaining terms.

Participant Name:____________________________________ Date: ________________

Signature: _______________________________________________________________

If Participant is under 18 years of age:

I am the parent or legal guardian of the Participant. I have read this two-page document, and I am signing

it freely. I understand the legal consequences of signing this document, including (a) release of University

from all liability on my and the Participant’s behalf, (b) waiver of my and the Participants’ right to sue, (c)

and assumption of all risks of the Participant’s participation in this Activity, including travel to and from the

Activity. I allow Participant to participate in this Activity. I understand that I am responsible for the

obligations and acts of Participant as described in this document. I agree to be bound by the terms of this

document.

__________ _________________________________

Signature of Minor Participant’s Parent/Guardian Date

____________________________________________

Minor Participant’s Name

Complete Internship description:

____________________________________________________________________________________