Name (last name first – please print or type) Student A#
Participant Local Address City, State, Zip Code
DESCRIPTION OF ACTIVITY and/or TRAVEL:
MODE OF TRANSPORTATION: (check one)
Page 3
In consideration for facilitating my participation in the Activity described above, I, for myself, my heirs, executors and administrators,
hereby release, hold harmless, discharge, and otherwise agree to indemnify Sul Ross State University (“University”), the Texas State
University System, their regents, employees, agents, and volunteers (“the Released Parties”) from and for any claims, demands,
liability, lawsuits, injuries (including death), property damage, attorney’s fees, expenses, costs, causes of action, judgments, or awards
of any kind or character (“Loss”) that may accrue, arise, or otherwise exist because of my participation in the Activity. I intend this
release to include any Loss sustained by a third party through whom or on behalf of whom (or whose estate) I may assert a claim,
lawsuit, or cause of action. I UNDERSTAND AND AGREE THAT THIS RELEASE, HOLD HARMLESS, AND INDEMNITY AGREEMENT
EXPRESSLY RELEASES, HOLDS HARMLESS, CONTRACTUALLY BINDS ME TO INDEMNIFY (I.E., REIMBURSE THE RELEASED PARTIES FOR
ANY LOSS THEY MAY SUSTAIN, RESULTING FROM A CLAIM BY A THIRD PARTY) AND OTHERWISE EXONERATES THE RELEASED
PARTIES FROM THE CONSEQUENCES OF THEIR OWN NEGLIGENCE, WHETHER THAT NEGLIGENCE IS THE SOLE OR CONTRIBUTING
CAUSE OF MY LOSS.
I intend this release, hold harmless and indemnity to be as broad and comprehensive as possible as I do not desire
that the Released Parties have any liability, directly to me, my spouse (if any), my child, or indirectly to any medical provider or insurer,
arising from my participation in the herein described Event and/or my presence on the above-named property or facilities.
ASSUMPTION OF RISK
I voluntarily choose to participate in the Activity, and hereby confirm that no one has compelled me to participate in the Activity. I
understand that there are inherent risks associated with the Activity. I further understand that participating in the Activity involves
some activities that can be both strenuous and physically demanding and could result in injury or even death. Such injuries may
include: scratches, scrapes, bruises, strains, sprains, broken bones, water-borne illnesses, hypothermia, injuries from impact with rocks,
or other river hazards, and drowning. I also understand that this is not a complete list of the possible injuries that may be sustained
from participating in the Activity. There are various hazards associated with the Activity, including, but not limited to, the varying
degrees of experience or lack of experience of other individuals participating in the Activity. I understand that these risks may result in
personal injury, property damage or death. On behalf of myself, my heirs, executors and administrators, I voluntarily assume any and
all risk of Loss as defined and described in the above Release of Liability and Indemnity Agreement.
BY SIGNING BELOW, I REPRESENT THAT I HAVE READ AND UNDERSTOOD WHAT IS WRITTEN ABOVE AND
THAT I VOLUTARILY BIND MYSELF TO THE TERMS AND CODITIONS STATED.
Return Page 3 to the Student Life Office Box C-121/ Room UC211
SUL ROSS STATE UNIVERSITY
A Member of the Texas State University System
ALPINE, TEXAS 79832
RELEASE OF LIABLITY, INDEMNIFICATION AND ASSUMPTION OF RISK AGREEMENT
RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT
I grant permission to the University’s staff to seek medical attention should the need arise and next of kin cannot be reached by
Date and Time of Departure(from Campus)
Date and Time of Arrival(to Campus)
University Vehicle
Personal Vehicle Other
