Student’s First Name
Student’s Last Name
1. In consideration for my child, , receiving permission to participate in the
Weatherford College Upward Bound program, I hereby RELEASE, WAIVE, and DISCHARGE Weatherford College, the Board
of Regents of the State of Texas, and the Board of Weatherford College, the State of Texas, their officers, servants
agents, or
employees, the Upward Bound program and its directors and employees (hereinafter referred to as RELEASEES) from any and
all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, that
may be sustained by my child, or to any property belonging to my child, while participating in the Upward Bound program, or
while in, on, upon, or traveling to and from any program activity where it is being conducted.
2. I am fully aware of the risks and hazards connected with allowing my child to participate in the Upward Bound program,
including the risk of physical injury or disability as the result of such injury, and I hereby allow my child to voluntarily participate
in said activity, and to enter the above-described premises and engage in such activity. I VOLUNTARILY ASSUME FULL
my child, or any loss or damage to property owned by my child, as a result of being engaged in such an activity.
3. I further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage or costs,
that may be incurred due to my child's participation in said activity.
4. It is my express intent that the Release and Hold Harmless Agreement shall bind the members of my family and spouse (if any), if
I am alive, and my heirs, assignees and personal representative, if I am not alive, shall be deemed as a RELEASE, WAIVER, and
DISCHARGE the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement
shall be construed in accordance with the laws of the State of Texas.
5. I understand that the release shall not be responsible for any medical costs associated with an injury that my child may sustain.
(See Medical Release Form).
6. I further agree to become familiar with and inform my child of the rules and regulations of the Upward Bound program, and agree
that I will further assume for my child the complete risk of any activity done in violation of any rule, directive, or instruction.
7. I also understand that I should, and am urged by Weatherford College to, obtain adequate health and accident insurance to cover
any personal injury to my child which may be sustained during the program or the transportation to and from said program and its
IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Liability
and Hold Harmless Agreement, understand it and statements or inducements, apart from the foregoing written agreement, have been
made; I am at least eighteen (18) years of age and fully competent and I execute this Release for full, adequate, and complete
consideration fully intending to be bound by same.
PARENT/GUADIAN: ___________________________ _____________________________ ____________
(Print Name of Parent) (Signature of Parent) (Date)
WITNESS: _____________________________ ____________________________________ ____________
(Print Name of Witness) (Signature of Witness) (Date)
This document will remain in effect for the duration of time the student is in
the Weatherford College Upward Bound Program.
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