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Activity Release and Indemnity Agreement for Participants (18 years or older)
Participant Name (
Print): ___________________________________________
Organization: ___________________________________________
Activity: ___________________________________________
(
Please describe specifically the activity)
___________________________________________
Activity Dates: ___________________________________________
This is a release of liability and assumption of risk agreement. Read it carefully and sign
below. Completion of this form is necessary in order to participate in this Activity. This
document cannot be altered or modified by any verbal or written statements.
_______ Releasees: The Board of Regents, The Texas State University System, Lamar University, and
all regents, employees, agents, and officers for these entities.
______ Release: In consideration for facilitating my participation in the Activity
described above (hereafter Activity), I release, discharge, and
agree not to sue Releasees for any claims, demands, actions, and
causes of action of any nature whatsoever including a claim of
negligence, arising out of any loss or damage to my property and
any injury, including death, that I may sustain whether or not
caused by the negligence of the Releasees, while participating in
the Activity, supervised or unsupervised, or while in
transportation to and from the Activity.
_______ Risks: To the best of my knowledge, I am in good health and have no physical limitations
that would preclude or impede my participation in this Activity. I am aware of the
risks and hazards connected with the Activity, and I elect to participate voluntarily
and engage in this Activity knowing that the Activity may be hazardous to my property
and me. I voluntarily and expressly agree and promise that I assume full
responsibility for property loss or damage, and for personal injury, including death
that I may sustain as a result of being engaged in this Activity, whether or not based
on the negligence or other wrongful conduct of Releasees.
______ Indemnity: I also agree to indemnify and hold harmless the Releasees from
any and all loss, liability, damage, or costs of any nature
whatsoever, including court costs and attorney’s fees, that they
may incur due to my participation in this Activity whether caused
by the negligence of Releasees or otherwise. For example, I
specifically agree to indemnify and hold harmless the Releasees
from losses they may incur as a result of my injuring another
person or damaging another person’s property while
participating in the Activity.
Initial
Initial
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