ASSUMPTION OF RISK
I/my child plan to participate in the Sam Houston State University (SHSU) sponsored activity described above. I have been
briefed about safety consciousness and preparedness during the above mentioned activity. I am aware that I/my child
has a personal duty and responsibility to exercise
common sense and to follow the safety standards, guidelines, and
established by the SHSU authority. I/my child will notify the SHSU authority if, at any point during the activity,
I/my child questions knowledge of such standards, guidelines and procedures and/or ability to participate in the activities
risk. I/my child is am aware that this activity may be led by an undergraduate
student(s). I/my child is am aware
that the use of alcohol, illegal drugs or the illegal use of legal drugs is prohibited and is
grounds for dismissal from this
activity and/or additional disciplinary action. I/my child is aware that participating in this
activity includes exposure to
inherent risks including, but not limited to, PERSONAL INJURY, DEATH,
or PROPERTY DAMAGE. I accept these risks. I
also affirm that I/my child currently have medical insurance.
I/my child is voluntarily participating and accept all risk and responsibility.
WAIVER AND RELEASE
In consideration of the permission given by Sam Houston State University (SHSU) to participate in the
activity, I, (for myself, my heirs, executors, and administrators), RELEASE, DISCHARGE, AND
AGREE TO INDEMNIFY SHSU,
the Board of Regents, Texas State University System, the trip leader(s), and all
of the university’s and Regents officers,
agents, volunteers and employees (the released parties) FROM ANY
AND ALL LIABILITY ARISING from or in connection
with my/my child’s participation in the above-mentioned activity,
REGARDLESS OF WHETHER SUCH LIABILITY IS CAUSED
BY THE NEGLIGENCE OF THE RELEASED
PARTIES. I INTEND THAT THE INDEMNITY PROVIDED IN THIS WAIVER AND
RELEASE IS INDEMNITY
BY ME AND MY CHILD TO THE RELEASED PARTIES FROM THE CONSEQUENCES OF THIER
WHETHER THAT NEGLIGENCE IS THE SOLE OR A CONCURRING CAUSE OF THE LIABILITY.
I have been informed and understand the risks and dangers inherent in the above described activity and
participate freely and without guarantee or compulsion. I am of lawful age and legally competent
and empowered to
execute this affirmation, waiver, and release on my own behalf.
I understand that photos and/or video taken of me/my child may be used for the purpose of promoting Sam
University (SHSU) and various programs of the institution in media that may include printed
material, web and/or
video. I agree to allow my/my child’s image to be used for this purpose and that any
likeness of me may be disseminated
for public release by Sam Houston State University (SHSU).
I HAVE READ AND UNDERSTAND THIS DOCUMENT,
AND AGREE THAT IT WILL LEGALLY BIND ME AND MY ESTATE.
Signature of Participant Date
Signature of Parent or Legal Guardian (if under 18) Date