T E X A S A & M
U N I V E R S I T Y A T G A L V E S T O
N
WAIVER, INDEMNIFICATION, AND MEDICAL TREATMENT
AUTHORIZATION FORM
1. EXCULPATORY CLAUSE.
In consideration for receiving permission to participate in any and all
activities of student transportation to College Station (herein referred to as
“activity”), which is sponsored by Texas A&M University at Galveston (herein
referred to as “sponsor”), a member of The Texas A&M University System, I
hereby release, waive, discharge, covenant not to sue, and agree to hold
harmless for any and all purposes sponsor, The Texas A&M University System,
the Board of Regents for The Texas A&M University System, and their members,
officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES or INDEMNITEES) from any and all liabilities, claims, demands,
injuries (including death), or damages, including court costs and attorney’s
fees and expenses, that may be sustained by me while participating in such
activity, while traveling to and from the activity, or while on the premises
owned or leased by RELEASEES, including injuries sustained as a
result of the sole, joint, or concurrent negligence, negligence per se,
statutory fault, or strict liability of RELEASEES. I understand
this waiver does not apply to injuries caused by intentional or grossly
negligent conduct.
2. INDEMNITY CLAUSE. I
am fully aware that there are inherent risks to myself and others involved
with this activity, including but not limited to
activities related to driving or riding in a vehicle, and I choose to
voluntarily participate in said activity with full knowledge that the
activity may be hazardous to me and my property, and to the person and
property of others. I acknowledge there may be physically strenuous
activities. I know of no medical reason why I should not participate.
I agree to indemnify and hold harmless INDEMNITEES from
any and all liabilities, claims, demands, injuries (including death), or
damages, including court costs and attorney’s fees and expenses, which may
occur to myself, other participants, and third-persons as a result of my
participation in said activity, including injuries sustained as a
result of the sole, joint, or concurrent negligence, negligence per se,
statutory fault, or strict liability of INDEMNITEES.
3. NO INSURANCE. I
understand that RELEASEES do not maintain any insurance policy covering any
circumstance arising from my participation in this activity or any event
related to that participation. As such, I am aware that I should review my
personal insurance coverage.
Sponsor does not carry
general liability insurance to cover claims arising from this activity so it
seeks a waiver of claims as additional consideration for the right to
participate so sponsor, a governmental unit of the State of Texas, can (a)
provide the activity at the lowest possible cost to participants; and (b)
provide access to a greater number of participants by expending limited
resources on program materials rather than on liability insurance.
4. BINDS HEIRS. It is
my express intent that this agreement shall bind the members of my family
and spouse, if I am alive, and my heirs, assigns and personal
representatives, if I am deceased, and shall be governed by the laws of the
State of Texas.
5. MEDICAL
AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, and WAIVER. I understand
RELEASEES cannot be expected to control all of the risks articulated in this
form and RELEASEES may need to respond to accidents and potential emergency
situations. Therefore, I hereby give my consent for any medical treatment
that may be required, as determined by a medical professional at the medical
facility, during my participation in this activity with the understanding
that the cost of any such treatment will be my responsibility. I agree to
indemnify and hold harmless INDEMNITEES for any costs incurred to treat me,
even if an INDEMNITEE has signed hospital documentation promising to pay for
the treatment due to my inability to sign the documentation. I further
agree to release,
waive, discharge, covenant not to sue, and agree to hold harmless for any
and all purposes, RELEASEES from any and all liabilities, claims, demands,
injuries (including death), or damages, including court costs and attorney’s
fees and expenses, that may be sustained by me while receiving medical care
or in deciding to seek medical care, including while traveling to and from a
medical care facility, including injuries sustained as a result of
the sole, joint, or concurrent negligence, negligence per se, statutory
fault, or strict liability of RELEASEES. I understand this
waiver does not apply to injuries caused by intentional or grossly negligent
conduct.
6. VOLUNTARY
SIGNATURE. In signing this agreement I acknowledge and represent that I
have read it, understand it, and sign it voluntarily as my own free act and
deed; sponsor has not made and I have not relied on any oral
representations, statements, or inducements apart from the terms contained
in this agreement. I execute this document for full, adequate and complete
consideration fully intending to be bound by the same, now and in the
future. For students engaging in extracurricular activities: I
understand I can choose not to sign this document and free myself from its
terms and the associated risks of the activity by simply not participating
in the activity and choosing some other activity available to me that has a
lower level of risk to me. I further understand this is a voluntary,
extracurricular activity; therefore it is not required for me to obtain
college credits and not participating in this activity will in no way hinder
my ability to obtain a degree from the university. For students going on
fieldtrips or other class-related activities: I understand participation
in this class/fieldtrip/activity is not mandatory and I will not be
penalized for failing to participate in this activity because an alternative
activity exists for which I can receive like credit. While I understand
alternative activities are available to me that do not have the risks
associated with this activity I still desire to voluntarily engage in this
activity. AGREEING TO THIS
DOCUMENT INVOLVES THE WAIVER OF VALUABLE LEGAL RIGHTS. CONSULT YOUR ATTORNEY
BEFORE AGREEING TO THIS DOCUMENT.
YOU MUST BE 18 OR OLDER
TO AGREE TO THIS DOCUMENT.
Participant Information
Name
UIN
Reservation Date
Did you pass the Alert Driving 15 Passenger Van Test?
Yes No
(A passing grade is required to drive)
Are you willing to drive? Yes
No
What is your reason for traveling to College Station?
Do
you agree that the information submitted is true and you agree with the
terms above?
I
Agree I Disagree
Please click the submit button only once.
TAMUS-OGC-Approved 08/29/2006
