AIR TRAVEL NOTIFICATION AND WAIVER
Notification by CSU to participant: You are intending to participate in a California State
University-affiliated program that requires air travel.
Air travel involves risks that could result in damage to property, injury to persons, and death.
Please be informed that the California State University assumes no liability for damage, injury,
and death that may occur during air travel undertaken by the California State University-affiliate
programs.
Your participation in the program is voluntary, and you participate at your own risk.
Prior to undertaking CSU-affiliated air travel, you will be required to sign the below "Release and
Hold-Harmless Statement." Please review the statement carefully before signing it.
WAIVER, RELEASE AND HOLD-HARMLESS STATEMENT
I, ____________________________, am a student at, or other non-working affiliate participant
of California State University Channel Islands.
I am/will be participating in a CSU-affiliated program that includes air travel. (CSU-affiliated
program includes any program offered by, or pursuant to a program of, the California State
University, any campus of the California State University, any student body organization, or any
organization affiliated with any such organization or with any combination thereof.)
My participation in this program is voluntary.
I have been informed and I understand that 1) air travel involves risks that can result in damage
to property, injury to persons, and death; and 2) the CSU assumes no liability for damage, injury,
or death occurring on such travel. With this knowledge and information, I agree to participate in
the program, and the air travel, at my own risk.
I release and hold harmless the State of California, the California State University, California State
University Channel Islands, and each and every officer, employee, volunteer and agent of each
of them, from any and all claims and causes of action that I may have against any of these
institutions or persons, by reason of any accident, illness, injury, death, or other consequences
resulting directly or indirectly from or in any manner arising out of, or in connection with, my
being a passenger on an airplane pursuant to my participation in the CSU-affiliated program.
This release and hold-harmless shall be binding on my heirs, assigns, successors, and all other
persons who may claim losses through me.
_________________________________ _______________________________ ____________
Student/Participant Signature Printed Name Date
_____________________________________________________________________________________
Address City State Zip Code
Revised 11/2018
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