Programs for Leadership and Service Education

Participant Waivers

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 information.

Sample Participant Waiver

[Name of Event]
[Name of Organization]
Butler University
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 information.

Printed Name Signature Emergency Contact Emergency Phone