Having participants sign waivers is only part of preparing for
your event These DO NOT release you from liability. It is your
responsibility to carefully think through your event, proactively
plan for any foreseeable risks, and manage it effectively. Work
closely with your advisor and meet with Programs for Leadership and
Service Education staff with any questions or clarification.
Below is a template that can be adapted and used for many
events. Please read it carefully and be aware of its content. Make
sure to include the same language at the top of each page to ensure
the information is being read by each participant.
There may be times when the use of this template is not
appropriate. If you ever have doubt or a question, please contact
Programs for Leadership and Service Education in order to work
together in finding the best way to promote safety.
Programs for Leadership and Service Education has also
created adapted waivers for drivers of personal vehicles and
students unable to travel with the group transportation. Contact
Programs for Leadership and Service Education for more
Sample Participant Waiver
[Name of Event]
[Name of Organization]
Assumption of Risk/Release of Liability Form
[Date of Event]
In consideration of my participation at the [name of
event], I expressly and knowingly release the
[name of organization], its representatives and
agents; the University, its officers, and employees, from any and
all claims and causes of action for property damage, personal
injury, or death sustained by me arising out of any travel or
activity conducted by or under the auspices of the [name of
organization] caused by risks associated by this activity
and/or the negligence of the sponsoring committee.
In addition, I understand and agree the [name of
organization] cannot be expected to control all possible
risks but may need to respond to accidents and potential emergency
situations. Therefore, I hereby give my consent for any medical
treatment that may be required during my attendance with the
understanding that the cost of any such treatment will be my
responsibility. The university does not carry medical or accidental
insurance for the activities mentioned. As such, participants
should review their personal insurance portfolio.
I voluntarily and knowingly agree to protect, hold harmless, and
indemnify the [name of organization], its
representatives and agents; the University, its officers, and
employees, against all claims, demands, or causes of actions for
property damage, personal injury, or death, including defense costs
and attorney's fees arising out of my participation in the
[name of event].
I have read the agreement and do willingly signify my agreement
for the consideration expressed and with a full understanding of
its purpose by signing below. I represent that I am eighteen (18)
years of age or older and am otherwise competent to execute this
agreement. I also understand that the information on this form may
be shared with the [name of organization] and
Butler University Administration.
By signing below, I agree that have read the above