DUE BEFORE YOU START YOUR SERVICE-LEARNING
RELEASE OF LIABILITY - REQUIRED
I, ___________________________________, ID # , am voluntarily entering into this release as part of my application for the Service-Learning Program for academic school year 2011-2012; and I agree to the terms set forth below:
I understand that the purpose and effect of this RELEASE OF LIABILITY is to release and insulate Rose State College, its agents, employees, representatives, and assigns from and against any claims, suits, or causes of action for injuries, death, damage, loss or expense incurred by or caused by me during my participation in the Service-Learning Program, caused or resulting from my negligence, or the negligence of any other person, group, or entity, whether intentional or unintentional.
I agree to accept full responsibility for, and I do hereby intentionally release the College, its agents, employees, representatives, and assigns from and against any claims, suits or causes of action for injury, death, damage, loss or expense incurred by me at any time resulting from or related to the Services-Learning Program, as a result of any act or omission to act by Rose State College, its agents, employees, representatives, and assigns which directly or indirectly caused or contributed to injuries, death(s), losses and expenses, even though said act or omission to act constituted negligence or other culpable conduct of or attributable to, the College in any respect, including, without limitation, lack of improper supervision, or breach of any statutory or regulatory duty or obligation. I hereby agree that this RELEASE OF LIABILITY shall be binding upon my heirs, executors, administrators and assignees at law, and shall be governed and interpreted in accordance with the laws of the State of Oklahoma.
It is understood that the College reserves the right to cancel, modify or terminate the Service-Learning Program if, in its sole judgment, conditions so dictate.
I have read the foregoing Release of Liability and fully understand the contents thereof
Dated
Print Name in Full of Student
REQUIRED Witnessed by_______________ _______________________________________
Signature of Student
Address of Witness
INDEMNIFICATION BY PARENT IF STUDENT IS A MINOR
I understand that in the event my child or any other party contemplated by this Release of Liability initiates or attempts to initiate a claim or cause of action of any kind whatsoever, that I will indemnify and hold harmless Rose State College, its agents, employees, representatives, and assigns from any liability resulting there from, including damages, costs, and related fees.
Dated
Printed Name in Full of Parent or Guardian
Witnessed by
Signature of Parent or Guardian
Address of Witness
