LIABILITY ACKNOWLEDGEMENT
I, __________________________________________(Please Print),
a student/faculty/staff member at North Carolina Wesleyan College, hereby
expressly acknowledge that I am fully aware of my personal liability
involved in driving my personal vehicle to an off-campus activity; that my
automobile insurance company is primarily responsible for any and all
claims for injuries and damages that may arise out of, or relate in any way to
travel to and from the activity.
Further, I, for myself, my heirs, personal representative and assigns,
do hereby release and forever discharge North Carolina Wesleyan College,
Incorporated and its trustees, officers, employees, agents, successors, and
assigns from any liability whatsoever; including, without limitations to any
and all claims for injuries (including death) or damages that arise out of, or
relate in any way to the off-campus activity.
REQUIRED:
Attached herewith are copies of my valid driver's license and proof
of current automobile liability insurance for the vehicle that I am driving
to the activity.
Executed this _____ day of _____________, 19___, under seal with
the intent that this shall be a "sealed instrument".
Student/Faculty/Staff Member Signature______________________(SEAL)
Witness Signature________________________________________(SEAL)
Professor/Sponsor Signature________________________________(SEAL)