Fillable Printable Hold Harmless Agreement/Waiver of Liability

Hold Harmless Agreement/Waiver of Liability

___________________________________________

In consideration of the sponsorship of the College of Saint Benedict /Saint John’s University

_______________________by the Joint Club Board and the administration of the institution;

And in further consideration of my participation in the ______________________________

<CLUB/ORGANIZATION NAME HERE>;

I hereby release and hold harmless the College of Saint Benedict/Saint John’s University, its

directors, regents/trustees, agents, employees and the Saint Benedict Senate/Saint John’s Senate

for any personal injuries I may sustain as a result of my participation in activities of the

______________________. This includes both on- and off-campus activities, trips, practices, etc.

I hereby agree to assume all risk of injury and loss that may arise as a result of participating in

this activity and further agrees to hold: The College of St. Benedict, St. John’s University,

CSB/SJU Division of Student Development, Dept. of Student Activities and Leadership

Development, the_________________________, and/or its agents, harmless for any injury or

loss that arises as a direct or indirect result of any act or omission of any third party.

I also understand that as a student of the College of Saint Benedict/Saint John’s University, I

must have adequate health insurance coverage, at my own expense.

I agree to follow all College of Saint Benedict/Saint John’s University policies and procedures,

including but not limited to Joint Club Board policies, policies outlined in Every Woman’s

Guide/J-Book, and Co-Funding Board policies.

___________________________ __________________________ __________________

Student’s Name Signature Date

Campus Address/Phone: _________________________________________________________

Emergency Contact Information:

Name: __________________________________ Relationship: ________________________

Address/Phone: ________________________________________________________________

Insurance Information (Carrier and Policy Number):

If student is under eighteen years of age, a parent or legal guardian must sign below.

As parent/legal guardian of ___________________________________, I hereby sign this Hold

Harmless Agreement on behalf of my son/daughter/ward.

_____________________________________ ___________________

Parent/Legal Guardian signature Date