Acceptance-of-Risk-and-Responsibility-Agreement
ACCEPTANCE OF RISKS AND RESPONSIBILITYAGREEMENT AND RELEASE OF LIABILITY This Acceptance of Risks and Responsibility Agreement and Release of Liability (“Agreement and Release”) is executed by:__________________________________(please print first and last name (“Participant”)) and is issued to WESTERN TECHNICAL COLLEGE (“COLLEGE”). Participant is participating in a COLLEGE affiliated Service-Learning project (“Activity”). This Activity is more fully described in the course syllabus and service-learning presentations, which has been provided to Participant. Participant understands that there are certain dangers, hazards, and risks inherent in the Activity. These include, but are not limited to, vehicular travel, physical labor, working in outdoor weather, (elaborate on other specifics related to your project) _______________________________________________________________________, etc. In certain circumstances, these dangers can include damage/destruction to property, severe bodily injury, and even death. Participant agrees to exercise reasonable care at all times with respect to Participant’s own safety and with respect to the safety of others. Participant agrees to abide by all rules, policies and procedures of the COLLEGE that are set forth in the Code of Conduct found in the COLLEGE’s Student Handbook, as well as any additional rules, policies and procedures of the location of the Activity. Participant has no health-related issues that would preclude or restrict participation in the Activity. Accordingly, Participant, on behalf of him/herself, the Participant’s spouse (if applicable), the Participant’s heirs, assigns, related individuals and related entities, does hereby WAIVE, RELEASE, AND DISCHARGE the COLLEGE, including its Board of Trustees/Directors, administrators, officers, employees, teachers, agents and insurers, from any and all claims, causes of action, suits, damages, or liabilities sounding in negligence, which the Participant has, shall have, or may have in the future against the COLLEGE arising out of, based on, related to, or connected with, the Participant’s enrollment and participation in the Activity. This release of liability does not, however, apply to any intentional or reckless acts or conduct by the COLLEGE. This Agreement and Release shall be governed by the laws of the State of Wisconsin, which shall be the forum for any lawsuits filed under, or incident to, this Agreement and Release. By signing this document, Participant acknowledges that s/he is fully informed of the contents of this Agreement and Release, and represents that s/he understands it. Participant is not relying on any oral or written representations, statements or inducements, apart from those made in this Agreement and Release. Participant is at least eighteen (18) years of age, and is competent to sign this document. If Participant is a minor under the age of eighteen (18), the parent and/or guardian acknowledges they are competent to sign this document on behalf of the Participant. [See the back of this document for signature section.] By signing this Agreement and Release, you give up substantial legal rights. Read and understand this entire document before you sign it. Participant Date Parent/Legal Guardian (Signature required if Participant is under age 18.) Date For College Use Only Student Card Number: 2 DMI AR FORM REV: 7/13
