Active Minds Liability Waiver (TCU STUDENT ORGANIZATION ACTIVITY PARTICIPATION RELEASE FORM)

Transcription

1 Active Minds Liability Waiver (TCU STUDENT ORGANIZATION ACTIVITY PARTICIPATION RELEASE FORM) You must complete this form for yourself. You are not allowed to complete this form on the behalf of anyone else. Complete this form if: - You are planning to participate in any activity associated with a student organization - You are participating in semester long activities within a given student organization (i.e. Social Activities Gamma Delta - Spring 2013) - You are at least 18-years-old - You are a current TCU student Do not complete this form if: - You are under 18-years-old - You are not a TCU student STUDENT/PARTICIPANT RELEASE AND INDEMNITY AGREEMENT BY COMPLETING THIS DOCUMENT, YOU ARE WAIVING CERTAIN LEGAL RIGHTS. PLEASE READ THIS DOCUMENT CAREFULLY BEFORE ELECTRONICALLY SIGNING. Which Student Organization's activity are you participating? [Required] You may only select one organization: - Select only one choice. - must select a value. Page 1 of 6 Active Minds Liability Waiver (TCU STUDENT ORGANIZATION ACTIVITY PARTICIPATION RELEASE FORM)

2 [ ] Active Minds [ ] Ad Association [ ] African Heritage Organization [ ] Alpha Chi Omega [ ] Alpha Delta Pi [ ] Alpha Epsilon Delta Texas Zeta Chapter [ ] Alpha Kappa Alpha Sorority, Inc. [ ] Alpha Lambda Delta Honor Society [ ] Alpha Omicron Pi Fraternity Inc. [ ] Alpha Phi Alpha Fraternity, Incorporated [ ] Alpha Phi Omega [ ] Alpha Psi Omega [ ] Ambassadors [ ] American Marketing Association [ ] American Sign Language [ ] Anthropological Society [ ] Army Reserve Officer Training Corps [ ] Arnold Air Society: General Samuel E. Anderson Squadron [ ] ArtOrg [ ] Asian Media Association [ ] Asian Student Association [ ] Association for Information Systems, Texas Christian University Chapter [ ] Athletic Training Students Association [ ] Autism Speaks U Texas Christian University [ ] Baptist Student Ministries [ ] Best Buddies [ ] Beta Alpha Psi [ ] Beta Theta Pi [ ] Beta Upsilon Chi [ ] Beyond Borders [ ] Black Student Association [ ] BNSF Next Generation Leadership Program [ ] Brite Student Association [ ] Brothers Of a Successful Standard [ ] Bryson Literary Society [ ] Calling in Action, Inc. [ ] Camp 14 Project at TCU [ ] Campus Crusade for Christ [ ] Capital Markets Club [ ] Catholic Community [ ] Chi Alpha [ ] Chi Delta Mu [ ] Chi Eta Phi Sorority, Incorporated [ ] Chi Omega - Rho Epsilon [ ] Chi Tau Epsilon [ ] Chi Upsilon Sigma National Latin Sorority, Inc. [ ] Chords for Kids [ ] Club Baseball [ ] Club Golf Team [ ] COE Frog Docs [ ] Collaborative Greek Alliance [ ] College Republicans [ ] Collegiate Entrepreneurs Organization [ ] Computer Science Society [ ] Cycling Club [ ] Delta Delta Delta [ ] Delta Gamma Fraternity [ ] Delta Sigma Pi [ ] Delta Sigma Theta Sorority, Inc [ ] Delta Tau Delta [ ] Design Focus [ ] Economics Club [ ] Elite Dance Club [ ] Energy Club [ ] Ensemble en Francais [ ] Environmental Club [ ] Eta Iota Sigma Sorority [ ] Exodus [ ] Falling Whistles Circle [ ] Fashion and Beyond [ ] Fellowship of Christian Athletes [ ] Financial Management Association [ ] Find Your Fit [ ] Fishing Club [ ] Foodies [ ] Freethinking Frogs [ ] Frog Talks Page 2 of 6 Active Minds Liability Waiver (TCU STUDENT ORGANIZATION ACTIVITY PARTICIPATION RELEASE FORM)

3 [ ] Frogs For Food [ ] Gamer's Guild [ ] Gamma Phi Beta [ ] Gamma Simga Alpha [ ] Gay Straight Alliance [ ] Generation Hope Laptop Program Campus Chapter [ ] Geology Club [ ] German Club [ ] Gluten Freedom [ ] Go Center [ ] Golden Key International Honour Society [ ] Graduate Real Estate Club [ ] Graduate Student Senate [ ] Gymnastics Club [ ] Habitat For Humanity [ ] Hall Crew [ ] Higher Education Leadership Organization [ ] Hillel [ ] Honors College Community Service [ ] Hui O Hawai'i [ ] HyperFrogs [ ] ICE HOCKEY CLUB [ ] Ignite Ministry [ ] Independent Greek Council [ ] Interfraternity Council [ ] Interior Design Association [ ] International Christian Fellowship [ ] International Student Association [ ] Invisible Children United [ ] Italian Club [ ] Japanese Club [ ] John V. Roach Honors Cabinet [ ] Kappa Alpha Psi Fraternity Inc. [ ] Kappa Alpha Theta [ ] Kappa Kappa Gamma [ ] Kappa Kappa Psi [ ] KAPPA LAMBDA DELTA SORORITY [ ] Kappa Pi International Honorary Fraternity [ ] Kappa Sigma Fraternity [ ] La Mesa Hispanica [ ] Lambda Chi Alpha - Iota Pi Zeta [ ] Lambda Pi Eta - National Honor Society for Undergraduates in Communication [ ] Lambda Theta Alpha Latin Sorority, Incorporated [ ] Lambda Theta Phi Latin Fraternity Inc. - Beta Pi Chapter [ ] Leadership For Life [ ] LEAPS [ ] Logos [ ] Love For Lancaster [ ] MBA Association [ ] MBA Consulting Club [ ] MBA Healthcare Club [ ] MBA Marketing Association [ ] MBA Women International [ ] Meals on Wheels Student Association [ ] Men's Club Volleyball [ ] Men's Lacrosse [ ] Men's Rugby [ ] Men's Soccer Club [ ] Mortar Board [ ] MTNA (Music Teachers National Association) [ ] Mu Phi Epsilon [ ] Multicultural Greek Council [ ] Music Educators Organization [ ] Musicians Mentoring Musicians [ ] Muslim Student Association [ ] National Association for the Advancement of Colored People [ ] National Pan-Hellenic Council [ ] National Residence Hall Honorary [ ] National Society of Collegiate Scholars [ ] National Student Speech-Language and Hearing Association [ ] Neeley Fellows Student Organization [ ] Neeley MBA Energy Club [ ] Net Impact [ ] Omega Delta Phi Fraternity Inc. [ ] Omega Psi Phi Fraternity, Inc. [ ] Order of Omega- Alpha Delta Chapter [ ] Organization for Supply Chain Studies [ ] OSA Page 3 of 6 Active Minds Liability Waiver (TCU STUDENT ORGANIZATION ACTIVITY PARTICIPATION RELEASE FORM)

4 [ ] Panhellenic Council [ ] People for Animal Well-Being [ ] Percussion Club [ ] Phi Alpha National Social Work Honors Society Iota Xi Chapter [ ] Phi Beta Sigma Fraternity, Incorporated [ ] Phi Delta Theta [ ] Phi Gamma Delta [ ] Phi Kappa Sigma: Beta Theta [ ] Phi Mu Alpha Sinfonia [ ] Phi Sigma Iota: Delta Delta Chapter at Texas Christian University [ ] Phi Upsilon Omicron [ ] Pi Beta Phi [ ] Pi Kappa Phi Fraternity [ ] Polo Club [ ] Pre-Dental Club [ ] Pre-Law Club [ ] Psi Chi [ ] Public Relations Student Society of America [ ] Quidditch Club [ ] Rangers [ ] Real Estate TCU [ ] Reformed University Fellowship [ ] Relay for Life Club [ ] Senseless Acts of Comedy [ ] Sigma Alpha Epsilon Fraternity [ ] Sigma Chi [ ] Sigma Gamma Epsilon [ ] Sigma Kappa Sorority [ ] Sigma Lambda Alpha Sorority, Inc. [ ] Sigma Phi Epsilon [ ] Sisters Transcending and Reaching Success [ ] Society for Human Resources Management [ ] Society of Composers [ ] Society of Physics Students [ ] Society of Women Engineers [ ] Sociological Society [ ] Soul Steppers [ ] Sports Networking Club [ ] Student Association of Social Work (SASW) [ ] Student Filmmakers Association [ ] Student Foundation [ ] Student Government Association [ ] Student Moblization [ ] Student Nurses Association [ ] Student Nutrition and Dietetic Association [ ] Student Organization Advisors [ ] Student Veterans Alliance [ ] Student YMCA (TCU) [ ] Students for Asian-Indian Cultural Awareness [ ] Tae Kwon Do Club at TCU [ ] Tau Beta Sigma [ ] TCU Alcohol & Drug Education Center [ ] TCU Campus Recreation [ ] TCU Community Involvement & Service Learning [ ] TCU Fraternity and Sorority Life [ ] TCU Frog Camp [ ] TCU Housing & Residence Life [ ] TCU Inclusiveness and Intercultural Services [ ] TCU Leadership Center [ ] TCU Religious & Spiritual Life [ ] TCU Student Activities [ ] TCU Student Development Services [ ] TCU Transfer Programs [ ] Tennis on Campus [ ] Texas Christian University Women Veterans Society [ ] The American Chemical Society Chapter at Texas Christian University [ ] The Art History Society [ ] The College of Science and Engineering Student Advisory Board [ ] The Knights Who Say Knit [ ] The TCU College Democrats [ ] The Winifred Bryan Horner Rhetoric Society [ ] thecrew [ ] To Write Love On Her Arms- TCU UChapter [ ] Triathlon Club [ ] Trombone Society [ ] Tuba/Euphonium Society at Texas Christian University [ ] Ultimate Frisbee Club [ ] United Latino Association Page 4 of 6 Active Minds Liability Waiver (TCU STUDENT ORGANIZATION ACTIVITY PARTICIPATION RELEASE FORM)

5 [ ] Up 'Til Dawn [ ] USITT Student Chapter- Texas Christian University [ ] V-Day Campaign 2011 (TCU) [ ] Veteran International Student Ambassador Program [ ] Vietnamese Student Association [ ] WakeTeam Club [ ] Water Polo Club [ ] Wesley Foundation [ ] Women's Business Network [ ] Women's Club Soccer [ ] Women's Rugby [ ] Women's Volleyball [ ] Word of Truth Ministries [ ] Wrestling Club [ ] Young Americans for Freedom [ ] Young Americans for Liberty [ ] Young Life [ ] Zeta Tau Alpha TCU Student ID # [Required] - Numeric - ex: 1111 First & Last Name [Required] Address [Required] - name@myschool.edu Activity or Program [Required] Semester or Dates of Participation (i.e. Fall 2013 or November 1-5, 2013) [Required] Agreement For and in consideration of being permitted to participate in the Course/Activity above (including related travel, if any), I, THE UNDERSIGNED, HEREBY FULLY RELEASE AND FOREVER DISCHARGE Texas Christian University and all instructors, sponsors, agents, employees, officers, trustees and affiliates of Texas Christian University (collectively "TCU"), of and from any and all liability to me, my personal representatives, assigns, heirs and next of kin, for any damage to or loss of my property, any injury to my person or my death or any one or more of the foregoing, arising directly or indirectly out of my participation for any purpose in the Course/Activity, INCLUDING ANY SUCH DAMAGE, LOSS OR INJURY THAT IS CAUSED BY ANY ACT OR OMISSION ON THE PART OF TCU, INCLUDING ANY NEGLIGENT CONDUCT OF TCU but excluding any gross negligence or willful misconduct of TCU. IT IS MY EXPRESS INTENT THAT THE ABOVE RELEASE INCLUDES THE RELEASE BY ME OF TCU FROM THE CONSEQUENCES OF TCU'S OWN NEGLIGENCE. THE ONLY CIRCUMSTANCE UNDER WHICH MY RELEASE OF TCU DOES NOT APPLY IS WITH RESPECT TO ANY OCCURRENCE RESULTING FROM THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF TCU. I FURTHER AGREE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS TCU for, from and against any and all liabilities, damages, claims, lawsuits, costs (including court costs, attorneys fees and costs of investigation), and actions of any kind or description for any damage to or loss of my property or the property of another, any injury to me or my death, or the injury to or death of any other person or any one or more of the foregoing, arising out of my participation for any purpose in the Course/Activity, INCLUDING ANY DAMAGE, LOSS OR INJURY CAUSED BY ANY ACT OR OMISSION ON THE PART OF TCU, INCLUDING ANY NEGLIGENT CONDUCT OF TCU but excluding any gross negligence or willful misconduct of TCU. IT IS MY EXPRESS INTENT THAT THE ABOVE INDEMNITY INCLUDES INDEMNIFICATION BY ME OF TCU FROM THE CONSEQUENCES OF TCU'S OWN NEGLIGENCE. THE ONLY CIRCUMSTANCE UNDER WHICH MY OBLIGATION TO INDEMNIFY TCU DOES NOT APPLY IS WITH RESPECT TO AN OCCURRENCE RESULTING FROM THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF TCU. By execution below I hereby acknowledge that I recognize and assume all of the risks associated with the Course/Activity. I ACKNOWLEDGE THAT IT IS IMPORTANT THAT I VERIFY THAT I HAVE INSURANCE COVERAGE WHICH EXTENDS TO ME WHILE PARTICIPATING IN THE COURSE/ACTIVITY, AND THAT I SECURE SUCH COVERAGE IF I DO NOT ALREADY HAVE IT. I understand that TCU does not provide such coverage, and that no insurance coverage may exist through TCU to cover any injuries or damages which I may sustain or claims which may arise as a result of my participation in the Course/Activity. The terms of this Release and Indemnity Agreement are to be governed by and construed under the laws of the State of Texas, and venue with respect to any dispute arising between TCU and any other party that involves this Release and Indemnity Agreement or my participation in the Course/Activity shall be exclusively in Tarrant County, Texas. Each provision of this Release and Indemnity Agreement is severable and if one portion is invalid or illegal, such invalid or illegal portion shall not apply, but the remaining portions shall nevertheless remain in full force and effect. I understand that the terms of the Release and Indemnity Agreement are contractual and not mere recitals, and that such terms are binding upon me, my heirs, personal representatives and assigns. In making this Release and Indemnity Agreement, I have not relied upon any statement or representation pertaining to this matter made by TCU or any other person or entity which is hereby released. - Select only one choice. [ ] I WARRANT THAT I HAVE CAREFULLY READ THIS DOCUMENT AND KNOW ITS CONTENTS, AND THAT I AM 18 YEARS OF AGE OR OLDER AND HAVE FULL AUTHORITY TO EXECUTE THIS DOCUMENT AND THAT I HAVE EXECUTED THIS DOCUMENT VOLUNTARILY AND AS MY OWN FREE ACT. I EXECUTE THIS DOCUMENT FULLY INTENDING TO BE BOUND BY ITS TERMS. Date Signed [Required] Enter today's date Page 5 of 6 Active Minds Liability Waiver (TCU STUDENT ORGANIZATION ACTIVITY PARTICIPATION RELEASE FORM)

6 If the Student/Participant is not eighteen (18) years of age or older, the signature of Student/Participant's parent or legal guardian is required. As parent or legal guardian of the above-mentioned Student/Participant, I agree to and approve the terms of this Release and Indemnity Agreement and consent to the Student/Participant's participation in the Course/Activity and warrant that I have full authority to do so on behalf of myself, the Student/Participant and the Student/Participant's heirs, personal representatives and assigns. I understand and assume the risks of the Student/Participant's participation in the Course/Activity. I, THE UNDERSIGNED, HEREBY FULLY RELEASE AND FOREVER DISCHARGE Texas Christian University and all instructors, sponsors, agents, employees, officers, trustees and affiliates of Texas Christian University (collectively "TCU"), of and from any and all liability to me, my personal representatives, assigns, heirs and next of kin, from any and all claims, demands, controversies, actions or causes of action, belonging to me or Student/Participant now or in the future for any damage to or loss of Student/Participant's property, and any injury to Student/Participant's person or Student/Participant's death or any one or more of the foregoing, arising directly or indirectly out of Student/Participant's participation for any purpose in the Course/Activity, INCLUDING ANY DAMAGE, LOSS OR INJURY CAUSED BY ANY ACT OR OMISSION ON THE PART OF TCU, INCLUDING ANY NEGLIGENT CONDUCT OF TCU but excluding any gross negligence or willful misconduct of TCU. IT IS MY EXPRESS INTENT THAT THE ABOVE RELEASE INCLUDES THE RELEASE BY ME OF TCU FROM THE CONSEQUENCES OF TCU'S OWN NEGLIGENCE. THE ONLY CIRCUMSTANCE UNDER WHICH MY RELEASE OF TCU DOES NOT APPLY IS WITH RESPECT TO ANY OCCURRENCE RESULTING FROM THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF TCU. I FURTHER AGREE TO INDEMNIFY, DEFEND, AND HOLD HARMLESS TCU for, from and against any and all liabilities, damages, claims, lawsuits, costs (including court costs, attorneys fees and costs of investigation), and actions of any kind or description for any damage to or loss of Student/Participant's property or the property of another, any injury to Student/Participant or any other person, any injury resulting in Student/Participant's death or the death of another or any one or more of the foregoing, arising out of Student/Participant's participation for any purpose in the Course/Activity, INCLUDING ANY DAMAGE, LOSS OR INJURY CAUSED BY ANY ACT OR OMISSION ON THE PART OF TCU, INCLUDING ANY NEGLIGENT CONDUCT OF TCU but excluding any gross negligence or willful misconduct of TCU. IT IS MY EXPRESS INTENT THAT THE ABOVE INDEMNITY INCLUDES INDEMNIFICATION BY ME OF TCU FROM THE CONSEQUENCES OF TCU'S OWN NEGLIGENCE. THE ONLY CIRCUMSTANCE UNDER WHICH MY OBLIGATION TO INDEMNIFY TCU DOES NOT APPLY IS WITH RESPECT TO AN OCCURRENCE RESULTING FROM THE GROSS NEGLIGENCE OR WILLFUL MISCONDUCT OF TCU. - Select only one choice. [ ] I Agree Printed Name of Parent or Legal Guardian Location of Activity or Program Page 6 of 6 Active Minds Liability Waiver (TCU STUDENT ORGANIZATION ACTIVITY PARTICIPATION RELEASE FORM)