Student Travel Assumption of Risk, Release, and Hold Harmless Agreement
THIS IS A LEGAL DOCUMENT. READ IT CAREFULLY AND OBTAIN LEGAL ASSISTANCE IF YOU DO NOT UNDERSTAND IT.
The above-named EFSC student requests permission to attend the Event described above, and hereby acknowledges:
My attendance at the Event is strictly voluntary, and I am under no obligation by EFSC to attend the Event; and
There are potential risks and hazards associated with the Event and its related travel and incidental activities, including
but not limited to, property damage, loss, illness, disease, or bodily and/or emotional injury, including death; and
Despite the potential risks and hazards associated with the Event and its related travel and incidental activities, I wish
to proceed, and freely accept and assume all risks and hazards that may arise from my attending the Event and that
could result in property damage, loss, illness, disease, bodily and/or emotional injury, or death, however caused.
Knowing these risks, and in consideration of EFSC allowing me to attend the Event, I, on behalf of myself and my heirs, personal
representatives, successors, and assigns, hereby release and hold harmless the District Board of Trustees of Eastern Florida State
College, Florida, its affiliated entities, and its trustees, officers, employees, agents, successors, and assigns (“the College”) from
any and all liability, claims, and causes of action for any and all property damage, loss, illness, disease, bodily and/or emotional
injury, or the consequences thereof, including death, resulting from or in any way connected with my attendance at the Event,
or my traveling to and from the Event, or my engaging in any other activities incident to the Event during the time period identified
above, whether caused by my actions or negligence or the actions or negligence of the College or any third parties or otherwise.
SIGNATURE OF STUDENT
I have read and agree with the above, and further agree to abide by any and all local, State, and Federal laws and ordinances,
as well as the EFSC Student Code of Conduct and applicable policies and procedures during the time period identified above.
Signature: __________________________________________________________ Date: _____________________________
FERPA WAIVER AND EMERGENCY CONTACT INFORMATION
I understand that under the Family Educational Rights and Privacy Act (“FERPA”), EFSC is required to keep confidential various
types of student records. I also understand that in case of an emergency, certain people may want to know or should know
about my whereabouts or condition. For that reason, during the time period identified above, I waive my FERPA rights as they
relate to my whereabouts and condition, and authorize EFSC to disclose in case of an emergency such information to:
Name: ____________________________________________________________ Relationship: ________________________
Phone: ______________________________________________ Email: ___________________________________________
Address: _____________________________________________ City: _____________________________ State: __________
FOR STUDENTS UNDER THE AGE OF 18
I am the parent or legal guardian of the above-named student. On behalf of myself and the above-named student, I agree to
the terms of this Student Travel Assumption of Risk, Release, and Hold Harmless Agreement.
Parent Name/Legal Guardian: __________________________________________ Relationship: _______________________
Signature: __________________________________________________________ Date:______________________________
Date and Estimated Time of Departure:
Date and Estimated Time of Return:
Name of EFSC Representative(s) Traveling/Supervising Event:
