STATE OF NORTH CAROLINA
NEW HANOVER COUNTY
RELEASE, ASSUMPTION OF RISK, AND WAIVER OF LIABILITY
I, ______________________, understand that my request to participate as an uncompensated
volunteer in the Department of Chemistry and Biochemistry, College of Arts and Sciences at the
University of North Carolina Wilmington has been accepted. I will be working with Dr.
____________ on ________________________ [insert description of “Project”]. I am
undertaking the Project for the educational and training benefits which will accrue to me. The
Project is under the direction of Dr. _____ and is part of his/her ongoing research at UNCW. I
will be under Dr. _________’s direction and control while working on this Project. The risks
associated with this Project include, but are not limited to, the following:
____________________________________. The length of time that I will be working on the
Project is uncertain, but it is anticipated that I will participate from _________, 200_ to
_________, 200_. I am free to cease my participation at any time, and UNCW may terminate my
participation at any time, with or without cause, and for any reason. No promises of future
employment or of favorable consideration for such employment have been made to me by anyone
at UNCW.
In consideration for my participation as a volunteer at UNCW, I for myself, my heirs, executors,
and administrators waive and release forever any and all rights for claims and damages that I may
have against UNCW, its trustees, its officers, its employees, and its agents in any manner due to
any personal injury (including death) or property loss sustained as the result of my participation
as a volunteer on the Project, due to negligence or other cause.
I acknowledge that I am not an employee of UNCW. I understand that as a volunteer, I must
abide by UNCW policies and code of conduct that include but are not limited to a prohibition
against illegal drugs and underage drinking.
With the Project having been fully explained to me and all of my questions answered to my
satisfaction, I agree to volunteer for the Project, fully aware of the activities and assuming all
risks that may be involved.
THIS IS A RELEASE OF YOUR LEGAL RIGHTS. READ CAREFULLY BEFORE
SIGNING.
Signature of Participant
Date
Signature of Department Chair
Date
If person is under the age of 18, signature of parent or guardian is required:
Parent Signature (on behalf of both parents)
Date
[This signed original of this form is to be kept on file in the departmental office for a period of
five years from the date of termination of the agreement. Copies must go to the participant, the
sponsoring faculty member, and the parent or guardian if appropriate.]