Acceptance-of-Risk-and-Responsibility-Agreement

Acceptance-of-Risk-and-Responsibility-Agreement



Microsoft Word – Acceptance-of-Risk-and-Responsibility-Agreement.doc





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