INTERNSHIP WAIVER & RELEASE OF LIABILITY
NOTICE: This release form is a contract with legal consequences. Please read it carefully before signing.
Student Name (Last, First, MI): ___________________________________ WNCC ID ________________________
Period of Internship: Semester: _________________ Academic Year: ____________________________
Internship Course: _____________________________________ Internship Site ________________________
In consideration for being allowed to participate in an internship as part of my academic pro
gram, I hereby acknowledge
and agree as follows:
I understand that the Western Community College Area, doing business as Western Nebraska Community College
and WNCC (hereinafter collectively “WNCC”) does not require me to participate in the internship and I have
voluntarily chosen to participate.
2. I understand and acknowledge that there are significant risks to which I may be exposed by participating in this
internship, including but not limited to, risks arising from:
● Commuting to and from the internship site, or while in the course of internship activities;
● Activities indoors and/or outdoors and working with equipment at the internship site;
● Acting in an unsupervised capacity while participating in the internship and the internship involves hazards that
are unknown and/or unseen.
3. I knowingly and voluntarily assume the risk that unexpected events may occur and result in harm, injury, or even
death to me while I am participating in internship work or activities or in connection with transportation to and from
the destinations or any associated food or lodging. I hereby and forever release, waive and discharge for myself, my
heirs, executors, administrators, legal representatives, assigns, and successors in interest, any and all claims,
demands, actions or right of action, of whatever kind or nature, either in law or equity, which I may have or accrue
against WNCC, its Board of Governors, administrators, officials, agents, officers, employees, and the suppliers of
equipment, materials and services (collectively known as WNCC), as well as those individuals, governments, and/or
business entities working with WNCC in the internship programs, (collectively known as placements), for any and all
damages which may be sustained by me directly or indirectly in connection with, or arising out of, my participation
or association with the class, internship, or travel related to any of the aforementioned activities or events.
4. I release WNCC from liability for any and all claims of negligence I may have or assert against them individually or
collectively, with the exception of gross negligence or willful and wanton misconduct. I understand that I am
responsible for any medical charges relating to any injury received, as a result of this activity, and it is strongly
recommended that I have adequate health and accident insurance coverage prior to starting this internship.
5. I have read and fully understand that this waiver and release of liability is intended to be as broad and inclusive as
permitted by the laws of the State of Nebraska and agree that if any part is held invalid, the remaining parts of this
waiver and release will continue in full force and effect as intended. I further agree the venue for any legal proceeding
shall be in the State of Nebraska.
PARENT OR GUARDIAN OF A MINOR:
I, as parent or guardian of the below named minor, a person under the age of 19 years, hereby give my permission for my child or
ward to participate in this internship and further agree, individually and on behalf of my child or ward, to the terms of the above
contract for waiver of legal rights.
Parent or Guardian Signature (if student is under 19)