____________________________ _______________________ _____________
Instructor's Name Course Number/Section Semester
Laboratory Activities
(Read carefully before signing)
The undersigned hereby acknowledges that participation in laboratory activities involves an inherent
risk of physical injury, understands further that all risks will be reduced as far as is possible by training
and supervision which may not prevent all injuries or damage, and therefore by the execution of this
release hereby assumes all such risks.
The undersigned further agrees that for the sole consideration of Bossier Parish Community College
allowing the undersigned to participate in Engineering Technology programs for which or in
connection with which the college has made available any equipment, facilities, or personnel for such
programs or activities, the undersigned does hereby release and forever discharge Bossier Parish
Community College; its faculty, staff and administration and; the Louisiana Board of Regents and
Louisiana Community and Technical College System, its members officially and individually, and its
officers, agents and employees of any and from all claims, demands, rights and causes of action of
whatever kind or nature, arising from and by reason of any and all known and unknown, foreseen and
unforeseen, bodily and personal injuries, damages to property, and the consequences thereof, resulting
from the undersigned’s participation in or in any way connected with such Engineering Technology
programs and/or laboratory activities.
I understand that the acceptance of this release and waiver of liability by Bossier Parish Community
College, the Louisiana Board of Regents and the Louisiana Community and Technical College System
shall not constitute nor be construed as a waiver, in whole or in part, of sovereign of official immunity
by said Board, its members, officers, agents and employees.
I certify that I have read and understand this release before signing the same on this ______day of
_______________, 20___.
Printed Name
Signed in the presence of (Witness)
Printed Name