Student Name: _____________________________________________________
Class Title: CRN: Term:
The undersigned does here by release and discharge CENTRAL OREGON COMMUNITY
COLLEGE (“COCC”), its employees, agents, officers, and directors for any and all claims,
demands, causes of action, damage, loss of services, costs and expenses in any way
resulting from any and all injury to person or property arising directly or indirectly out of
the student’s participation in the above activity.
Further, the undersigned agrees to indemnify and hold forever harmless COCC, its
employees, agents, officers and directors from any and all injuries, damages, costs,
attorney’s fees whatsoever which may arise out of the student’s participation in the above
The undersigned further consents and authorizes the representatives of COCC on the
undersigned behalf to obtain any necessary medical treatment or hospitalization or such
other care necessary for the health and welfare of the named student during the class trip
or activity, and the undersigned agrees to be responsible for and pay the costs of such
medical treatment or hospitalization.
This release of liability and indemnification agreement shall be binding on the heirs,
successors and personal representatives of the student and the undersigned.
I have read the foregoing release of liability and the indemnification agreement and
acknowledge that the provisions are contractual and not a mere recital and I understand I
am bound by the terms hereof by placing my signature hereon.
Student Signature: _________________________________Date: _________________
(If the student is under the age of 18, a parent/guardian must also sign to consent and grant
permission for named student to participate in the above listed activity.)
Parent Signature: ____________________________________
CE-Consent & Liability Waiver-11/7/18
Consent & Liability Waiver
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