LIABILITY RELEASE AND ASSUMPTION OF RISK
Trip/Activity: _________________________________________ Date of Trip: ________________
Description of Activity: _____________________________________________________________
__________________________________________________________________________________
I _______________________________understand and appreciate the risks inherent in the nature of the
Activity described above and assume those risks, which vary from one activity to another, but may
include, but not be limited to, physical and/or psychological injury, pain, suffering, illness, disfigurement,
temporary or permanent disability, death or economic loss, and acknowledge and agree;
1. M
y participation in such Activity is voluntary and optional. I understand that there are ri
sks
associated with my participation in this Activity. Injury may arise from my own or others action,
in
action or negligence or the condition of the Activity location. Nonetheless, I assume all risks o
f
m
y participation in this Activity, whether known or unknown to me, including travel to and from
the Activity or any events incidental to this Activity.
2. I willi
ngly agree to comply with the stated and customary terms and conditions for participation
.
If, h
owever, I observe any unusual significant hazard during my presence or participation, I
will
remove myself from participation and bring such hazard to the attention of the nearest official
im
mediately.
3. I will abide by all rules and policies provided by the event organizers, and I accept that failure to
do so could result in being disqualified from participation in future events.
4. I have read and understand the Farmingdale State College Student Code of Conduct and
its
co
ntents. I acknowledge its applicability to my participation in this program. I agree to be civil
towards Farmingdale State College students, staff and others while participating on this trip o
r
activ
ity. I further agree to follow the direction of all Farmingdale State College personnel in all
matters connected with the activity.
5. Farmingdale State College, the State University of New York and the State of New York are no
t
li
able for any injury, damage, cost, claim demand, causes of action or other loss or liability which
I may cause or incur, or may cause others to incur, while participating in the above refe
renced
trip
or activity, which may be sponsored by Farmingdale State College and/or its affiliates.
6. In consideration for being allowed to participate in this Activity, I, for myself and on behalf of my
heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND
HOLD HARMLESS FARMINGDALE STATE COLLEGE, its officers, officials, agents and/or employee
s,
clu
bs, and organizations, from ANY AND ALL CLAIMS, INCLUDING CLAIMS RESULTING IN INJ
URY,
ILL
NESS, DISABILITY, DEATH, I may suffer or which may result from my participation in thi
s
Activit
y, travel to and from the Activity or any events incidental to this Activity, to the fulles
t
ex
tent permitted by law.
7. I specifically acknowledge that: (a) no oral representations statements or inducements, apar
t
fro
m this written agreement, have been made; (b) I am executing this liability release form fo
r
fu
ll, adequate and complete consideration and I fully intend to be bound by the sam
e.
