Please select the trip you are attending and your affiliation with Valparaiso University
WAIVER AND RELEASE AGREEMENT
Non-Student/Employee Participation in a Valparaiso University Travel Activity
In consideration for being permitted to participate in the Activity, I hereby agree and represent that:
I have or will secure health to provide adequate coverage for any injuries or illnesses that I may sustain or
experience while participating in the Activity. By my signature below, I certify that I have confirmed that my
health care coverage will adequately cover me while outside the United States (if applicable), and hereby release
VU, its employees, officers, directors, students, or agents from any responsibility or liability for expenses incurred
by me for injuries, illnesses (including death) or repatriation (if applicable) that I may incur because of those
injuries, illnesses or repatriation.
I understand that, although VU will attempt to maintain the Activity as described in its web sites, publications
and brochures, it reserves the right to change the Activity, including the itinerary, travel arrangements, or
accommodations, at any time and for any reason, with or without notice, and that VU, its employees, officers,
directors, students and or, shall be responsible or liable for any expenses or losses that I may sustain because of
these changes.
I understand that VU reserves the right to decline to retain me in the Activity at any time should my actions
or general behavior, in the sole discretion of VU or its representative, be determined to impede or obstruct the
progress of the Activity in any way.
I understand that, although VU has made reasonable efforts to assure my safety while participating in the Activity
that there are unavoidable risks in travel, and I hereby release and promise not to sue VU, its employees, officers,
directors, students, or agents for any damages or injury (including death) caused by, deriving from, or associated
with my participation in the Activity, except for such damages or injury as may be caused by the gross negligence
or willful misconduct of the employees or agents of VU.
I agree that, should any provision or aspect of this agreement be found to be unenforceable, that all remaining
provisions of this agreement will remain in full force and effect.
I represent that my agreement to the provisions herein wholly voluntary, and further understand that, prior to
signing this agreement, I have the right to consult with the adviser, counselor, or attorney of my choice.
I agree that, should there be any dispute concerning my participation the Activity that would require the
adjudication of a court of law, such adjudication will occur in the courts of, and be determined by the laws of, the
State of Indiana.
This agreement represents my complete understanding with VU concerning VU’s responsibility and liability
for my participation in the Activity, supersedes any previous or contemporaneous understandings I may have
had with VU on this subject, whether written or oral, and cannot be changed or amended in any way without my
written concurrence.
I represent that I am at least eighteen years of age or, if not, that I have secured below the signature of my parent
or guardian as well as my own.
THIS IS A RELEASE OF LEGAL RIGHTS. READ AND BE CERTAIN YOU UNDERSTAND IT BEFORE
SIGNING.
I, electronically acknowledge, I have read this release and understand all of its terms. By entering my name I execute it
voluntarily and with full knowledge of its significance. (Under 18 requires parental/guardian signature too.)