***If you are under 18 years of age, a parent or legal guardian must read and sign this document.
GETTYSBURG COLLEGE
O
FFICE OF EXPERIENTIAL EDUCATION
I
NDEMNITY RELEASE AND WAIVER
I am about to be engaged in the (list activity and location) _________________________________ Ascent program of the Gettysburg
College Office of Experiential Education (“Program”). Please read and initial each statement below acknowledging your understanding of
each.
RECOGNITION OF RISKS. I hereby acknowledge that I am participating in physical and recreational activities with the full realization
that they may involve a significant risk of bodily injury, including death or damage to property of myself and others. These risks include,
but are not limited to, the following:
Physical exertion, such as:
• Lifting, spotting, holding, catching other
individuals
• Lifting fully loaded packs, kayaks, and other
equipment
• Light jogging, running, quick movements
• Climbing
• Scrambling, climbing on rocks
• Stretching exercises
Environmental hazards, such as
• Uneven, rough terrain
• Hot, exposed climate
• Cold, exposed climate
• Unpredictable weather
• Unpredictable conditions (rock falls, high swells, lightning, rain, slippery rocks, etc.)
• Unpredictable contact with wildlife
• Contact with plants, insects and other naturally occurring phenomenon, often of unknown variety or origin
I realize that it is not possible to list specifically each and every risk. However, knowing the material risks and
appreciating, knowing and reasonably anticipating that injuries and even death are possible, I hereby expressly assume all
of the risks of injury or death that could occur by reason of my participation in the Program and all related activities,
including travel. __________
VOLUNTARY PARTICIPATION. I certify that my attendance and participation this Program and related activities is
voluntary and participation is not required for any course or degree requirement of the College. I further certify that I am
not an employee, servant or agent of the College. __________
ASSUMPTION OF RISKS AND RELEASE. I agree that, in exchange for and in consideration of the College’s
permitting me to participate in the Program, I hereby assume all the risks associated with the Program,
including but not limited to the use of College facilities and equipment and agree to release and hold harmless
Gettysburg College, its trustees, officers, agents, and employees, from any and all liability, actions, causes of
action, negligence, debts, claims, or demands of any kind and nature whatsoever including, but not limited to,
claims for negligence, recklessness or any other form of action for which a release may be legally given
(including attorneys’ fees and costs) which may arise by or in connection with my participation in any
activities related to the Program. __________
HOLD HARMLESS AND INDEMNIFICATION. In exchange for and in consideration of the College’s permitting me
to participate in the Program, I agree further to hold harmless and indemnify the College, its trustees,
officers, agents and employees from any and all liability, actions, causes of action, negligence, debts, claims or
demands of any kind and nature whatsoever (including attorneys’ fees and costs) by any person or the
College which may arise by or in connection with my conduct while participating in the Program. __________
PROMISE TO FOLLOW INSTRUCTIONS. I understand that while participating in the Program, I must follow the
instructions and directions provided by College personnel and that I must abide by the policies of Gettysburg College. My
failure to follow instructions or directions may result in my immediate expulsion from the Program. __________
I understand that I cannot consume, use or be under the influence of alcohol or consciousness-altering drugs, whether
obtained or taken legally or not, while participating in the Program and that my failure to abide by this rule will result in my
immediate expulsion from the Program. (Unless specifically incorporated into the trip design, i.e. wine tasting.)
__________
In signing this document I acknowledge that I am 18 years of age or older, that I have had an opportunity to
ask any questions I have about this document, that I have read it, that I understand it, that I have signed it
knowingly and voluntarily, and that I accept and intend to be legally bound by its terms.
Date: _________________ Signature: ____________________________________
Please print name: ____________________________________
