ACCEPTANCE OF RISK
RELEASE AND HOLD HARMLESS AGREEMENT
Florida Institute of Technology
■
Oce for Risk Management
150 West University Boulevard, Melbourne, FL 32901-6975
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321-674-8885
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Fax 321-674-7748
fbaarman@t.edu
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oridatech.edu
466-0719
I hereby release, waive and covenant not to sue Florida Institute of Technology, Inc., its subsidiaries and and their respective ocers, directors, trustees,
employees, agents and independent contractors (herein collectively the “Released Parties”), with respect to any and all liabilities, claims, demands,
causes of action, damages, losses, costs or expenses (including court costs and attorneys’ fees) of any kind or nature whatsoever (hereinafter
“Liabilities”) which may arise out of, result from, or relate in any way to my vehicle remaining on campus during the summer months, including without
limitation Liabilities related to damage to and/or of loss of my property, and including without limitation claims for Liabilities caused in whole or in part
by the negligent acts or omissions of the Released Parties.
I further agree that if, anyone on my behalf, makes a claim for any Liabilities against any of the Released Parties, I will indemnify, defend and hold
harmless each of the Released Parties from and against any such Liabilities which may be incurred as a result of such claim.
I acknowledge and agree that the execution and delivery of this agreement is a condition of Florida Institute of Technology permitting me to leave my
vehicle on campus between academic terms.
The university requires and I agree to the following:
üThe vehicle doors and windows are to be locked
üAll valuables are to be removed
üThe vehicle must be registered with the Oce of Security
üA key for the vehicle is to be turned into the Oce of Security
üIf a cover is put on the car, it will be secured appropriately
The university reserves the right to:
üTow the vehicle as necessary
Contact Information
Name ____________________________________________________________ Cell Phone Number ______________________________________________________
Student ID Number ____________________________
___
________________________ Start Date ________________________ End Date _______________________
Mother’s Name _____________________________________
__
_______________ Mother’s Cell Phone Number ____________________________________________
Father’s Name ______________________________________
__
______________ Father’s Cell Phone Number ____________________________________________
Vehicle Information
Vehicle Make _____________________________________________________ License Plate Number ___________________________________ State ____________
Model _______________________________________________________________ VIN Number __________________________________________________________
Decal Number ______________________________________ Expires______________________
TEMPORARY STORAGE OF VEHICLES DURING THE OWNER’S ABSENCE FROM CAMPUS SHALL BE LIMITED TO
THE TOP FLOOR OF THE SOUTH CAMPUS PARKING STRUCTURE.
T E I I , , I
:
Date picked up keys ____________________________ Returned by ____________________________
______________________________________________________________
Student Signature
______________________________________________________________
Student Name (Print)
___________________________________
Date
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