Release and Indemnification Form
This form must be completed prior to your participated in a college sponsored trip.
I freely and voluntarily sign this release form. I understand that there may be dangers inherent in my participation in this program and in any transportation to or from the program. I understand that while participating in the program, I may suffer physical injury or my property may be damaged or I may cause physical injury to others or damage their property. I assume full responsibility for any injury or damage to myself, my property or to others or their property incurred while participating in or traveling to or from the program. I understand that I am primarily responsible for my personal safety.
I represent that I am over the age of 18 and have no physical, mental, or emotional problems, nor any history of such problems, that will in any way impair my ability to safely participate in this trip. I assume full responsibility for any injury or illness I may incur or any damage to my property that may occur while I am participating in this program, including, without limitation, expenses for medical care.
I release and waive any and all claim which I may ever have against Canisius University, its directors, officers, agents or employees arising out of or in any way related to my participation in the program, whether caused by my negligence or the negligence of others, and whether for bodily illness or injury, property damage or loss, or otherwise.
I am fully familiar with the rules and regulations applicable to students participating in this program. I further agree to indemnify and hold Canisius University, its directors, officers, agents, or employees harmless against any loss or claim incurred as a result in my failure to abide by the rules and regulations or as a result of other inappropriate conduct on my part
This release and indemnification shall be binding on my heirs, successors, and assigns.
