RELEASE AND INDEMNIFICATION FORM

State University of New York at Oswego
RELEASE AND INDEMNIFICATION FORM
1.
I/We, the undersigned, our heirs, executors, administrators, successors, and assigns, covenant and agree that we
will not sue, or bring, or in any way aid, any legal action or proceeding against the State of New York, its legal
representative, or any and all other persons for whose acts or to whom it might be liable, or the State of New
York for any and all claims, demands, damages, costs, expenses, and compensation, incurred by reason of
failure and refusal of the undersigned to conform to the requirements of said State University of New York for
participants in the summer Intensive English Program sponsored by State University of New York.
2.
I/We, the undersigned, hereby agree to indemnify and save harmless the State of New York, the State
University of New York at Oswego and all officers, employees, and other agents and servants thereof, whether
same or serving in claims, demands, costs, expenses, actions, and causes of action for loss of or damage(s) to
property, personal injury or injuries, or death sustained by the undersigned student arising out of any travel or
other activity conducted by or under the control of the State of New York or the State University of New York
at Oswego with respect to the Summer Intensive Program or programs to which this document applies or shall
apply.
3.
I/We, the undersigned, our heirs, executors, administrators, successors, and assigns (jointly and severally) do
hereby acknowledge complete responsibility for all doctor, hospital, dental, first aid, and other medical
expenses, and for transportation, room and board, and personal expenses which
__________________________________________
Full Name of Student
may incur while participating in the summer Intensive English Program sponsored by the State University of
New York, and further covenant and agree that I we will at all times hereafter keep and save harmless and
indemnify the State University of New York, its legal representatives, and any and all other persons for whose
acts or to whom it might be liable, and the State of New York, may incur by reason of the failure and refusal of
the undersigned to conform to requirements of said State University of New York for participants in the study
abroad program sponsored by the State University of New York.
CONDITIONS OF RESPONSIBILITIES TO STUDENTS AND THEIR PARENTS:
1.
2.
3.
4.
The student will participate fully in the program.
Any student under 21 years of age must have parental approval to register in the program.
The student understands that the program director may terminate his or her participation in the program if the
student:
A. takes any action endangering himself/herself or others;
B. does anything that is harmful to or incompatible with the best interest and welfare of the program;
C. fails to make full payment of the program cost
The student will abide by the rules of the University and the laws of New York State, and will be sent home if
these rules and laws are violated.
Acknowledgement and Release
I/We, the undersigned, have read, fully understand, and accept without qualification everything as written in this
document.
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Parent/Guardian Full Name
____________________________________
Parent/ Guardian Signature
____________________________________
Signature of Student
Date: _______________________________