Fillable ASSUMPTION OF RISK, WAIVER AND RELEASE (Atlantic Cape Community College)

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ASSUMPTION OF RISK, WAIVER AND RELEASE (Atlantic Cape Community College)

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Revised: 04/14/2020
ASSUMPTION OF RISK, WAIVER AND RELEASE
Procedure 212.1 – Supplement 1
Name of Club_______________________________________________________________
Release executed by_____________________________________ (print name of student.) in
favor of the Atlantic Cape Community College and all of the employees, agents, servants and
representatives thereof.
I will be participating in the upcoming trip to: (please print all information)
_____________________________________________________________________________
_____________________________________________________________________________
Date(s) of Travel:
I have examined the itinerary for this trip, and I am fully familiar with the various modes of
travel and accommodation schedule. In recognition and appreciation of the normal risks and
dangers related to the various modes of transportation necessary to participate in this trip, I do
hereby agree to assume all such risks surrounding my participation in the trip, and the travel and
accommodations related thereto.
I further do, for myself, my heirs, and personal representatives, agree to defend, hold harmless,
indemnify and release and forever discharge Atlantic Cape any and all of its officers, agents,
servants and employees from and against any and all damage or inconvenience to personal
property and/or my person which may result from participation in this trip and related events.
I further understand that if a private vehicle is utilized to any College sponsored event, the
automobile insurance is primary, and the College Student Accident insurance is not applicable.
I hereby certify that I have read this document, and I fully understand its terms and provisions.
Any questions
that I have about the event described herein, and the contents of this document have been fully
explained to my satisfaction.
In witness whereof, I have caused this release to be executed this _____ day of ______________
(month) _________ (year).
_____________________________________________________________________________
Student Signature
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_____________________________________________________________________________
Advisor Signature
Date Submitted:________________________________________________________________
19
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ASSUMPTION OF RISK, WAIVER AND RELEASE (Atlantic Cape Community College)

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Completed 20 September 2020

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