Page 1


The undersigned (“Traveler”), as a member of _________________________________, a sanctioned student organization, has been approved to travel to an off-campus student activity for certain travel to be funded by the UA Division of Student Affairs (“Travel”). In consideration of the educational opportunities afforded, the undersigned agrees and acknowledges as follows: “Liabilities” shall mean any and all known and unknown, foreseen and unforeseen, claims, actions, suits, proceedings, damages, costs, attorney fees, litigation costs, and other expenses arising out of, connected with, or resulting from participation in the Travel, including claims for personal injury or death, claims by third parties for any damages related to any activities of the Traveler, such as damage to UA funded hotel rooms or UA automobiles, and claims related to Travel on automobiles which are not operated, owned or leased by UA. “Travel Destination” is to: ___________________________________________________ on or about the following dates: _______________________________________________________. “Traveler” is _______________________________, whose date of birth is ______________ and whose CWID is _________________. Traveler agrees to this document on behalf of him/herself, and his/her heirs, assigns, and next of kin. “UA” includes The Board of Trustees of the University of Alabama, its affiliated foundations, trustees, officers, employees, agents, volunteers, and representatives. Release. Traveler hereby knowingly and voluntarily releases UA from any and all Liabilities related to the Travel. This is intended to discharge in advance UA and waive all Liabilities related to the Travel. Assumption of Risk. Traveler assumes responsibility for making Travel arrangements. Traveler understands that the Travel is wholly voluntary, and that it involves risks. Traveler has conducted, or had the opportunity to conduct, his/her own investigation, and willingly accepts such risks which may result from the decision to Travel. Traveler understands and acknowledges that Travel may cause Traveler to suffer damage to property, expense, injury, severe health problems, or even death, and Traveler assumes and accepts any and all such risks. Risks include, without limitation: travel risks (such as accidents, crashes, and risks from autos not operated by UA, and resulting property damage or expense); premises risks, including those that may be owned by others (such as hotels, gas stations, bus stations, airports, poorly maintained roads, or restaurants); injury risks from collisions or accidents (such as cuts, bruises, broken bones, concussion, paralysis, death, etc.); weather risks (such as rain, storms, hurricanes or tornados, lightning, heat or cold); risks from others (such as transmitted illnesses, injury, loss of property due to crime, or others’ actions or crashes); and other risks beyond the control of UA or others, or otherwise revealed to the Traveler.

Health Care, Insurance, and Other Costs. Traveler understands that UA does not accept responsibility or liability for providing health care services or health care insurance for Traveler in regard to the Travel or otherwise. Personal Automobiles. UA does not accept responsibility or liability for providing automobile or traveler’s insurance for Traveler, or for any other costs incurred in connection with the Travel, such as gas, wear or damage to an automobile, towing, etc. UA does not assume any Liabilities, and Traveler specifically releases UA, holds UA harmless from, and indemnifies UA for any Liabilities related to personal travel or automobiles. Indemnification. Traveler agrees to release, hold harmless, and indemnify UA from and against any and Liabilities related to the Travel, including any and all damages which may be charged by third parties as a result of property damage or other damage caused by Traveler. General Terms and Conditions. . Traveler agrees to the “General Terms and Conditions: Travel Funding Requests,” which are incorporated herein by reference. In further clarification, but not limitation of the same, the Traveler understands that his/her student account may be charged in the event of property or other damage, and that such unpaid charges may prevent subsequent registration, graduation, and transcript issuance. Failure to meet financial obligations of any kind to the University could also subject the student to eviction from University housing; suspension of future services; referral of the student’s delinquent account to a collection agency; and the assessment of additional late payment charges, transcript hold fees, attorney’s fees, and other costs and charges necessary for the collection of any amount not paid when due. Traveler further understands that he/she is bound by the Student Code of Conduct, whether on campus or not. Acknowledgement. Traveler has read and voluntarily enters into this document, based on his/her own knowledge. If Traveler is under the age of 19, this document is entered into by Traveler’s Parent/Guardian who warrants his/her legal responsibility, custody, and authority to speak for the Traveler and binds him/herself, Traveler, and their heirs, assigns, and next of kin hereto. Student’s name (print): ____________________________________________________ Student’s Phone: _________________ Student’s Email: _________________________ Signature of Traveler: ______________________________________________________ Parent/Guardian’s name (print): _____________________________________________ Signature of Parent/Guardian (if student is under the age of 19): ________________________________________________________________________ Date: ___________________________________________________________________

University Funded Travel -Individual Release and Acknowledgement  

“UA” includes The Board of Trustees of the University of Alabama, its affiliated foundations, trustees, officers, employees, agents, volunte...