Field Trip Waiver of Liability / Hold Harmless Agreement
2
5.0 In signing this Release, I acknowledge and represent that I have fully informed myself of the
content of the foregoing waiver of liability and hold harmless agreement by reading it before I sign it, and
I understand that I sign this document as my own free act and deed; no oral representations, statements, or
inducements, apart from the foregoing written statement, have been made. I understand that the
Institution does not require me to participate in this activity, but I want to do so, despite the possible
dangers and risks and despite this Release. I further state that I am at least eighteen (18) years of age and
fully competent to sign this Agreement; and that I execute this release for full, adequate, ad complete
consideration fully intending to be bound by the same. I further state that there are no health-related
reasons or problems which preclude or restrict my participation in this activity, and that I have adequate
health insurance necessary to provide for and pay any medical costs that may be attendant as a result of
injury to me.
6.0 I further agree that this Release shall be construed in accordance with the laws of the State of
Ohio. If any term or provision of this Release shall be held illegal, unenforceable, or in conflict with any
law governing this Release the validity of the remaining portions shall not be affected thereby.
IN WITNESS WHEREOF, I have executed this release this day of , 20
Participant’s Name: ________________________________________________________
Phone: __________________________________________________________________
Address (Street/City/Zip):___________________________________________________
Participant’s Signature: _____________________________________________________
Date: ___________________________________________________________________
Emergency Contact: _______________________________________________________
Phone: __________________________________________________________________
________________________________________________________________________
Parent’s Signature (if under 18 yrs.)
________________________________________________________________________
Witness Signature (must be at least 18 yrs.)
** Please contact the SSCC Webmaster at webmaster@sscc.edu for suggested updates or changes to this form **
