Lamar State College – Port Arthur
BLANKET LIABILITY RELEASE & INDEMNITY AGREEMENT
August 2019- August 2020
Name: _____________________________
Date of Birth: _____________________________
Organization: _____________________________
Activity: _____________________________
Being 18 years of age or older, in consideration of being allowed to travel in conjunction with
the Lamar State College-Port Arthur activity listed above, this acknowledges that I choose to
attend the event(s) described above. I (for myself, my heirs, executors, and administrators)
release, discharge, and agree to indemnify the Board of Regents, Texas State University System;
Lamar State College-Port Arthur; and all regents and employees and the same from any claims,
personal injury, or property damage that I may sustain from any cause in connection with my
participation in the activity, regardless of whether such injury or property damage is caused in
whole or in part by the negligence of those indemnified. I agree to accept medical treatment
should it become necessary for my well being.
I certify that I have read and understand this agreement and that I may be giving up legal rights
which I may otherwise have.
___________________________
Student’s Signature Date
Being legally responsible for the above listed minor, I grant permission for our child to
participate in the activity named above on the date shown. In consideration for her/his being
allowed to participate in the activity listed above, this acknowledges that I authorize on behalf of
my minor listed above, has chosen and will be traveling on their own to attend the event(s)
described above. We (for ourselves, our heirs, our minor, executors, and administrators) release,
discharge, and agree to indemnify Lamar State College-Port Arthur, the Texas State University
System; and all of their agents and employees from any claims, personal injury, or property
damage that may occur from any cause in connection with the activity, regardless of whether
such injury or property damage is caused in whole or in part by the negligence of those
indemnified.
I certify that I have read and understand this agreement and that I may be giving up legal rights
which I may otherwise have.
___________________________
Parent/Guardian Signature Date
__________________________
Parent/Guardian Signature Date
07/27/15 revised
