Parent/Guardian Release and Waiver Form
You are receiving this online form from the Student Activities Office at Carleton College because your child plans to travel off-campus AND is under the age of 18. Any minor attending college sponsored activities off-campus must have approval from their parent/guardian. Please read the information below, sign, and return to the Student Activities Office via email: SAO@carleton.edu. If you have any questions regarding the content of this form, please contact Carleton's Risk Manager at (507) 222-4178.
Carleton College
Waiver of Liability, Assumption of Risk, and Indemnity Agreement
WAIVER: In consideration of being permitted to participate in any way in (Trip/Event description completed below) hereinafter called “The Activity”, I agree, for myself, my heirs, administrators, personal representatives, and/or assigns, that I do hereby release, hold harmless, and discharge Carleton College, its officers, trustees, employees, agents and others acting on its behalf (hereinafter collectively referred to as “ASSOCIATES”), of and from all claims, demands, causes of action and legal liability, whether the same be known or unknown, anticipated or unanticipated, due to Carleton College’s and/or its ASSOCIATES’ ordinary negligence; and I do further agree that, except in the event of Carleton College’s and/or its ASSOCIATES’ gross negligence and willful and wanton misconduct, I shall not bring any claims, demands, legal actions and causes of action, against Carleton College and/or its ASSOCIATES as stated above in this clause, for any economic and/or non-economic losses due to bodily injury, death, and/or property damage sustained by me and/or my minor children and/or legal wards, if any, arising from, but not limited to, participation in The Activity.
ASSUMPTION OF RISK: Participation in The Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from: (1) minor injuries such as scratches, bruises, and sprains; (2) major injuries such as eye injury or loss of sight, joint or back injuries, travel related injuries, heart attacks, and concussions to; (3): catastrophic injuries including paralysis and death. To the extent my participation in the Activity involves leaving the premises of the Carleton College campus, I understand that Carleton College does not always arrange or supervise transportation to or from campus and that students may be required to exercise their own judgment in arranging transportation or agreeing to ride with other student drivers. I hereby confirm that I have voluntarily chosen to participate in The Activity, that I have investigated the demands and requirements of The Activity, and that I am physically and emotionally fit to participate in The Activity. In the event of illness or injury, I authorize Carleton College and/or its ASSOCIATES to administer and/or secure medical treatment on behalf of my child.
RISK OF CONCUSSION: As the responsible adult responsible for choosing healthcare for my child, I have the direct responsibility for immediately reporting all of my injuries and illnesses to the sports medicine staff of my institution (e.g., team physician, athletic training staff), Campus Security, or the College Risk Manager. I recognize that the true physical condition of my child is dependent upon an accurate medical history and a full disclosure of any symptoms, complaints, prior injuries and/or disabilities experienced. I hereby affirm that I have fully disclosed in writing any prior medical conditions and will also disclose any future conditions to the sports medicine staff or Carleton's Risk Manager.
I further understand that there is a possibility that participation in The Activity may result in a head injury and/or concussion and a concussion is a potentially serious head injury that can result in severe consequences if not taken seriously from the start. I understand that my child will not return to play (in practice or games) or other activities if experiencing concussion-like signs and symptoms following a blow to the head or body and that a repeat concussion is more likely when a student returns to play before symptoms resolve. I understand that helmets, face shields, mouth guards and other protective equipment does not eliminate the risk of concussions and that purposeful head and neck contact in any sport is not permitted. I agree that I will immediately report to medical staff if my child observes a teammate suffering from any suspected signs and symptoms of a concussion. I acknowledge that the institution has the authority to permanently retire an athlete from sports or similar activities if it determines the risks of concussive injury while playing present a serious threat to my safety and well-being. When relevant, my child has been provided with education on head injuries and understand the importance of immediately reporting symptoms of a head injury/concussion to my sports medicine staff or Carleton's Risk Manager.
I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in The Activity. I hereby assert that my child's participation is voluntary and that I knowingly assume all such risks.
Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD Carleton College HARMLESS from any and all claims, actions, suits, procedures, costs (including but not limited to any medical treatment secured on my behalf) , expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in The Activity and to reimburse them for any such expense incurred.
Severability: I expressly agree that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of Minnesota and that if any of its provisions are held to be invalid, the balance shall, notwithstanding, continue in full legal force and effect.