St. Petersburg College RELEASE OF LIABILITY, ASSUMPTIONOF RISK AND INDEMNITY Please enable JavaScript in your browser to complete this form.Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Codein consideration of being granted permission to take or participate in at St. Petersburg College, or other college-sponsored event or activity, do hereby release, and forever discharge the Board of Trustees of St. Petersburg College, the college, its officers, employees, and agents of and from any and every claim, demand, action, or right of action, of whatever kind or nature, either in law or equity arising from or by reason of or including any loss, damage or injury including death that I may suffer as a result of my participation in the above course or activity specifically including any loss, damage, or injury, including death that I may suffer as a result of the negligence of the Board of Trustees of St. Petersburg College, its Trustees, officers, employees or agents. It is my desire to participate in the above course or activity and I am aware of the potential risks and hazards inherent in participation in the above course or activity, which I voluntarily enter into. Further, the course of instruction or activity that I am involved in as described above includes the potential risks of incurring loss, damages and/or injuries, including death, which may be sustained by me or to my property. Having voluntarily entered into said course of instruction or activity, I hereby acknowledge that I knowingly agree to assume the risks of loss, damage or injury including death that may be sustained by me or to any of my property. In addition, should this release relate to a travel activity, I am aware of the potential risks of vehicle accidents, of violence, of hijacking or other acts of terrorism, and I specifically include these potential risks within the scope of this release. I further voluntarily assume all risks of loss, damage, or injury, including death that may be sustained by me or to any property of mine relating to travel activity. I understand that should I choose to drive my personal vehicle that my personal vehicle insurance will be responsible for any liability connected with the transportation of myself and any other passengers. I further hereby agree to hold the Board of Trustees of the St. Petersburg College, its trustees, officers, employees and agents harmless from any and all liability, claims, demands or actions whatsoever arising out of any loss, damage or injury, including death, that may be caused or sustained by me as a result of my participation in the above course or activity. This Release of Liability, Assumption of Risk and Indemnity shall be binding upon the student/participant, the parents/ guardians of the student/participant (if student/participant is under 18 or incompetent), distributees, heirs, next of kin, personal representatives, executors, administrators and assigns of the student/participant and of the undersigned. In signing this, I acknowledge that I have read the foregoing, that I understand and acknowledge the significance and consequence of this Release of Liability, Assumption of Risk and Indemnity agreement, and that I am signing it voluntarily *FirstLastStudent Number, if applicableDate Parents or legal guardians of student/participant under 18 or incompetent must complete the following: I, *FirstLastofAddress Line 1CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Codethe mother/father/guardian of *FirstLastdo hereby agree to all the provisions of the above (Student/Participant) Release on behalf of my son/daughter/ward. My name below represents my signature. *FirstLastDate The Board of Trustees of St. Petersburg College affirms its equal opportunity policy in accordance with the provisions of the Florida Educational Equity Act and all other relevant state and federal laws, rules and regulations. The college will not discriminate on the basis of race, color, ethnicity, religion, sex, age, national origin, marital status, pregnancy, sexual orientation, gender identity, genetic information, or against any qualified individual with disabilities in its employment practices or in the admission and treatment of students. Recognizing that sexual harassment constitutes discrimination on the basis of sex and violates this Rule, the college will not tolerate such conduct. Should you experience such behavior, please contact Pamela Smith, the director of EA/EO/Title IX Coordinator at 727-341-3261; by mail at P.O. Box 13489, St. Petersburg, FL 33733-3489; or by email at eaeo_director@spcollege.edu.Submit
