RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK
AND INDEMNITY AGREEMENT
This form is to be signed by all students, volunteers, or non-employees who voluntarily
desire to self-transport and choose to obtain/provide their own transportation. This form must be
completed, signed and turned in to the Upward Bound Programs who will share with the D&E
Office of Academic Affairs prior to departure for events.
I,
hereby acknowledge that I choose to drive/carpool to and from the Challenge Sessions, Upward
Bound Events, Summer Academy, Bridge Program or when arriving, being collected, picked up
or dropped off at transportation stops (hereinafter “Student Activity”). I have decided to arrange
for other transportation so that I can attend and/or participate in the Student Activity.
In consideration for using my own transportation, I hereby acknowledge and agree to the
following:
RULES AND REQUIREMENTS: I understand that I am responsible for all costs and expenses
related to my transportation. I understand that it is my responsibility, if using my personal
vehicle, that I have the minimum automobile liability insurance coverage required by law. I
understand and agree that Davis & Elkins College’s insurance will not cover any liability caused
by the use of a personal vehicle. I further understand and agree that any occupants in my vehicle
on this trip will not be covered by insurance carried by Davis & Elkins College and any risk
taken by having them as passengers in my car will be borne by me/my personal insurance carrier.
I understand and agree that all passengers in my vehicle who are students of the Davis & Elkins
College Upward Bound Programs shall have executed a release before departing for the
Student Activity.
ASSUMPTION OF RISK:I understand and acknowledge that there are potential risks involved
with traveling to and from the Davis & Elkins College Upward Bound program events and
activities both known and unknown to me.
I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, BOTH KNOWN
AND UNKNOWN, EVEN IF ARISING FROM THE ACTS OF THE RELEASES,
UNLESS THE RISKS SOLELY ARISE FROM THE RELEASEES’ (AS DEFINED
HEREIN) NEGLIGENCE, GROSS NEGLIGENCE, OR INTENTIONAL MISCONDUCT
AND I ASSUME FULL RESPONSIBILITY FOR MY PARTICIPATION IN THE
STUDENT ACTIVITY.
RELEASE AND WAIVER OF LIABILITY: I, on behalf of myself, my personal
representatives, heirs, executors, administrators, agents, and assigns, HEREBY RELEASE,
WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Davis & Elkins College, D&E
Upward Bound including its governing board, trustees, directors, officers, employees, and any
students, agents orvolunteers acting at Davis & Elkins College’s direction (collectively referred
to as “Releasees”) shall not be held liable for any claims relating to my self-transportation, including my operation
of my vehicle. I further understand that if I take any transportation other than Davis & Elkins
College transportation, Releasees shall not be held liable for any damage, loss or injury which
may be sustained by me in consequence of my transportation REGARDLESS OF WHETHER
THE INJURY, DAMAGE OR DEATH OCCURS WHILE IN, ON, UPON, OR IN
TRANSIT, TO OR FROM THE PREMISES WHERE THE ACTIVITY, OR ANY
LOCATION ADJUNCT TO THE ACTIVITY, OCCURS OR IS BEING CONDUCTED.
Davis & Elkins College expressly disclaims liability for actions of third parties, which includes
but is not limited to students, agents, or volunteers who are not acting under the direction and
control of Davis & Elkins College. I, hereby release Releasees from any and all liability,
including any and all claims, demands, causes of action (known or unknown), suits, or judgments
of any and every kind (including attorneys’ fees), arising from any injury, damage, or death that I
may suffer as a result of actions of any third parties who are not Releasees.
INDEMNITY: I, on behalf of myself, my personal representatives, heirs, executors,
administrators, agents, and assigns, agree to hold harmless the Releasees from any and all
liability, including any and all claims, demands, causes of action (known or unknown), suits, or
judgments of any and every kind (including attorneys’ fees) including any made by a third-party,
arising from any injury, damage or death that I or any person traveling with me may suffer as a
result of my self-transport to the above-mentioned Student Activity.
I further agree that, in the event that I or any of my family members, personal representatives,
heirs, executors, administrators, agents, assigns, or any other third party attempts to assert any
claims, demands, causes of action (known or unknown), suits, or judgments of any and every
kind (including attorneys’ fees), arising from any injury, damage, or death to me, including but
not limited to any injury resulting from my own negligence, gross negligence or intentional
misconduct during or related to the Student Activity, I AGREE TO DEFEND AND
INDEMNIFY RELEASEES AGAINST SUCH CLAIMS, DEMANDS, CAUSES OF
ACTION (KNOWN OR UNKNOWN), SUITS, AND/OR JUDGMENTS OF ANY AND
EVERY KIND (INCLUDING ATTORNEYS’ FEES) TO THE FULLEST EXTENT
PERMITTED BY LAW.
CHOICE OF LAW: I hereby agree that this Agreement shall be construed in accordance with
the laws of the State of West Virginia, notwithstanding the location of the above mentioned
event, the route of travel or the location of my personal residence.
SEVERABILITY: If any term or provision of this Agreement shall be held illegal,
unenforceable, or in conflict with any law governing this Agreement, the validity of the
remaining portions shall not be affected thereby.
I hereby acknowledge that I have read, understand, and will abide by each of the terms
and conditions of this Agreement. I understand that I may seek legal counsel of my own
choosing to fully explain any terms of this Agreement to me before I sign it.
Signature of Parent/Guardian for Participants Who Are Minors:
I certify that I have custody of the student or am the legal guardian of the student by court order.
I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND AND AGREE TO ITS
TERMS. I AM AWARE THAT THIS AGREEMENT INCLUDES A RELEASE AND
WAIVER OF LIABILITY, AN ASSUMPTION OF RISK, AND AN AGREEMENT TO
INDEMNIFY RELEASEES.
