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Fillable Printable Hold Harmless Agreement/Waiver of Liability

Fillable Printable Hold Harmless Agreement/Waiver of Liability

Hold Harmless Agreement/Waiver of Liability

Hold Harmless Agreement/Waiver of Liability

Hold Harmless Agreement/Waiver of Liability
___________________________________________
<CLUB/ORGANIZATION NAME HERE>
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;
<CLUB/ORGANIZATION NAME HERE>
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.
<CLUB/ORGANIZATION NAME HERE>
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
<CLUB/ORGANIZATION NAME HERE>
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
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