By signing below you verify that the information provided is true and accurate to your knowledge.
Student's Signature
Parent's Signature
Parent's Signature
WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
1. In consideration for my child, ________________________, participating in the University of North Texas Upward Bound Program, I hereby RELEASE, WAIVE, DISCHARGE, and HOLD HARMLESS the University of North Texas, the Board of Regents, the State of Texas, his officers, servants, agents, employees and volunteers, the Upward Bound Program and its directors, (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 the program 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 named premises and engage in such activity. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY that may be sustained by 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 incur due to my child’s participation in said programs.
4. It is my express intent that this 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, and shall be deemed as a RELEASE, WAIVER, AND DISCHARGE of 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 Releasees will not be responsible for any medical costs associated with any injury that my child may sustain, and I agree to execute a Medical Authorization Permission/Release to obtain reasonable medical care for my child while participating in the program.
6. I further agree to become familiar with and inform my child of the rules and regulations of the Upward Bound Program. 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 RELEASEES 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 activities.
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 or Legal Guardian of Participant's Signature
Witness' Signature
Father/Guardian 1's Signature
Mother/Guardian 2's Signature
By selecting 'I Agree' and submitting this form, I certify that the above information is correct to the best of my knowledge. I understand that this information is being provided as a matter of record; it will be kept strictly confidential. I authorize this program to obtain copies of my transcripts, test scores, financial aid awards, and other materials necessary for participation in the program. I will also grant permission for my photograph, photographic image, and/or video recorded image to be published in materials such as newsletters, annual reports, recruiting presentations, web pages, e-Profiles, etc., and release this program from any liabilities.
Student's Signature: