WAIVER OF LIABILITY & HOLD HARMLESS AGREEMENT
Please read this document carefully. It affects any rights you may have if you are injured or
otherwise suffer damages during these Iowa State University research/education activities.
WHEREAS I (indicate full name), _________________________________________
am about to participate in research and education activities associated with Iowa State
University and Fred Janzen’s Turtle Camp, I acknowledge that I understand that in
consideration for my being permitted to participate in said program I do hereby for
myself, the members of my family and spouse if I am alive, and my heirs, assigns, and
personal representatives if I am deceased, acknowledge and assume the risk of
participation in the program, and do hereby RELEASE AND FOREVER DISCHARGE
the State of Iowa, State Board of Regents, Iowa State University of Science and
Technology, and all their officers, faculty or employees (herein after referred to as
“Releasees”), whether accompanying said program or otherwise, from any and all claims,
demands, actions or causes of action on account of any injury to me or my property or on
account of my death which may occur from any cause during the said program, or any
continuances thereof; and I do hereby expressly covenant and agree to refrain from
bringing suit or proceedings at law or in equity or otherwise as provided by law, against
any of said bodies or persons on account of any and all such claims, demands, actions or
causes of action.
I further AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES from
any loss, liability, damage, or cost, including court costs and attorney’s fees, that they
may incur due to my participation in said program.
I understand that personally owned automobiles used in conjunction with this program are
not covered by the University for property damage or liability. I understand that I must
carry auto liability insurance as required by the State of Iowa.
IN SIGNING THIS RELEASE I ACKNOWLEDGE AND REPRESENT THAT I have read the
foregoing Waiver of Liability and Hold Harmless Agreement, understand it and sign it
voluntarily as my own free act and deed; no oral representations, statements, or inducements
apart from the foregoing written agreement have been made; I am at least eighteen (18) years of
age and fully competent (if not eighteen, my parent(s) or guardian(s) agree with the terms of this
document and sign it as such); and I execute this Release for full, adequate and complete
consideration fully intending to be bound by same.
_____________________________________________
Student’s Signature
_________________
Date
_____________________________________________
Parent’s/Guardian’s Signature if Student <18 Years Old
_________________
Date
Name of student:_________________________________
Permission to Ride in ISU Vehicle
If under 21 or not employed by Iowa State University:
I give permission for my child to ride in an ISU vehicle during Turtle Camp (May-June 2016).
Signature (Parent or Guardian)______________________________ Date __________________
Release Agreement
Turtle Camp/Iowa State University
May-June 2016
I understand that in the event medical care is needed, every attempt will be made immediately to
contact the parent/guardian(s) listed on this form. In the event that I/we cannot be reached in an
emergency during Turtle Camp (May-June), I hereby give my permission to the physician or
dentist selected by the Turtle Camp leader to hospitalize, to secure medical treatment and/or
order an injection, anesthesia, or surgery for my child as deemed necessary.
I understand that all reasonable safety precautions will be taken at all times by Turtle Camp and
its agents during Turtle Camp. I understand the possibility of unforeseen hazards and know the
inherent possibility of risk; I agree not to hold Turtle Camp, its leaders, employees, agents, and
volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this
form.
Parent/Guardian signature: _____________________________________ Date: _____________
Printed name of parent/guardian: __________________________________________________
Photo and Video Release Form
I hereby grant Iowa State University and the Turtle Camp Program permission to use my likeness
in a photograph and/or video in any and all of its publications, including website entries, without
payment or any other consideration. I understand and agree that these materials will become the
property of the Iowa State University and the Turtle Camp Program and will not be returned. I
hereby irrevocably authorize Iowa State University and the Turtle Camp Program to edit, alter,
copy, exhibit, publish or distribute these photo and/or videos for purposes of publicizing Iowa
State University and the Turtle Camp Program or for any other lawful purpose. In addition, I
waive the right to inspect or approve the finished product, including written or electronic copy,
wherein my likeness appears. Additionally, I waive any right to royalties or other compensation
arising or related to the use of the photograph and/or videos. I hereby hold harmless and release
and forever discharge Iowa State University and the Turtle Camp Program from all claims,
demands, and causes of action which I, my heirs, representatives, executors, administrators, or
any other persons action on my behalf or on behalf of my estate have or may have by reason of
this authorization.
I am 21 years of age and competent to contract in my own name. I have read this release before
signing below and I fully understand the contents, meaning, and impact of this release.
Student Signature: _____________________________________________ Date: ____________
Printed Name: _________________________________________________________________
If the person signing is under age 21, there must be consent by a parent or guardian, as follows:
I hereby certify that I am the parent of guardian of ____________________________________,
named above, and do hereby give my consent without reservation to the foregoing on behalf of
this person.
Parent/Guardian: _____________________________________________ Date: _____________
Printed Name: _________________________________________________________________