Brandeis University
Consent Form and Release
______________________
I _________________, by my signature below, hereby knowingly, willingly and
voluntarily consent to participate in a trip with _____________ project in
____________from_______________. As this is a University sponsored trip I agree to
not consume alcohol or use illegal substances regardless or the legal age in my country of
travel as outlined in Students Rights & Community Standards.
I hereby acknowledge and understand that Brandeis University neither accepts nor
assumes responsibility for my welfare, or for any injuries, claims or losses arising from
my participation in the trip. In consideration for my participation in the trip, I, on behalf
of myself, my executors, heirs, administrators or assigns, hereby release and forever
discharge Brandeis University, its Trustees, officers, employees, agents or student
groups, of and from any claims or causes of action arising from my participation in the
trip. In addition, I hereby agree to release, indemnify and forever discharge Brandeis
University of and from contribution or indemnification with respect to any claim made
against me by any person or entity in connection therewith, or against Brandeis in
connection with my acts or omissions during the trip.
I hereby acknowledge that I have read and understood the above statements, and I
represent that I am of the specified legal age in my State of residence to bind myself to
this Release. This instrument has been executed in and shall be governed by the laws of
the Commonwealth of Massachusetts.
Signature_________________________________ Date_________________________
Name Printed_____________________________