Assumption of Risks, Indemnification, and Waiver of Liability
Participant’s Name: _________________________________________________________
Participant’s Address: _________________________________________________________
This Assumption of Risks, Indemnification, and Waiver of Liability (“Release”) is intended to
protect all participants and personnel involved in the class [INSERT CLASS NAME], [INSERT
COURSE NUMBER] (“Class”) at American University (“University”). All participants and any
parent or legal guardian of any participant under the age of eighteen (18) years must sign this form
to indicate agreement with its provisions and obtain permission to participate.
As you know, enrollment in the Class includes your participation on several projects off campus
(“Class Projects”). Class Projects include without limitation [DESCRIBE THE TYPES OF
PROJECTS].
Program Conditions and Rules: In signing this Release, I agree and/or represent that:
1.
2.
3.
4.
I will conduct myself in a safe and prudent manner while participating in the Class Projects.
I understand that I am expected to follow the directions of the Class Projects supervisor;
I will observe all applicable rules of the off campus sites;
I will observe all applicable rules, including the University’s Student Conduct Code, which
may be located at www.american.edu/handbook/conduct.html; and
5. I understand that if I do not comply with rules one through four or otherwise conduct
myself in a responsible manner, the University may remove me from the Class Projects.
Fitness to Participate and Emergency Medical Treatment: I represent to the University that
there are no health-related reasons or problems of which I am aware that preclude or restrict me
from participating in the Class Projects. I hereby authorize the University to secure necessary
emergency medical treatment in the event of injury or illness while participating in the Class Projects.
Assumption of Risks: I understand that although the University is sponsoring the Class Projects,
the University does not assume responsibility for any loss, injury or damage to person or property in
connection with the Class Projects which results from causes beyond the control of, and without
fault or negligence of the University.
I agree that my decision enroll in the Class and to participate in the Class Projects is entirely my own
choice and voluntary. I understand that participation in the Class Projects described above, involve
risks not found on the University campus. The risks for these Class Projects and related travel are
significant and include without limitation risk of death or serious bodily injury. Understanding these
risks, I agree that I am knowingly and voluntarily assuming them.
Indemnification & Waiver of Liability. Knowing the risks described above, I, on behalf of
myself, my family, heirs, and representatives, accept those risks and hereby agree to defend,
indemnify, and hold harmless the University, its trustees, officers, employees, and agents,
from any and all liability, claims, demands, rights, causes of action for personal illness,
injuries, death, or loss which may occur en route to, during, from or as a result of my
participation in the Class Projects.
I have read and understand the above provisions and agree to be bound by them, as
indicated by my signature below.
_________________________________
Participant’s Signature
Date
_________________________________
Participant (Print)
All Students under the age of eighteen must have their legal guardian complete the section
below.
I, _______________________, am the parent or legal guardian of the above Participant,
_______________________. I have read the foregoing Assumption of Risk, Indemnification, and
Waiver of Liability, and I agree that I will be legally responsible for the obligations and acts of the
Participation as described in this Agreement, and I agree for myself and for the Participant, to be
bound by its terms.
_____________________________________________________________
(Signature of legal guardian for a student under age 18)
Date
_____________________________________________________________
Printed name of legal guardian
Emergency Contact Information
Name of Contact 1: ______________________________________________________________
Relationship to Student: _______________________Contact Telephone No.: _________________
Name of Contact 2: ______________________________________________________________
Relationship to Student: _______________________Contact Telephone No.: _________________