Hold Harmless Release Agreement Event: ___________________________________ Date (s) : _________________________________ Place: ____________________________________ 1. I agree that my participation in the ___________________________________ is entirely voluntary. 2. Therefore, I agree on behalf of myself, my assigns, executors, and heirs, to release, indemnify, and hold harmless the University of the Incarnate Word and its trustees, officers, agents and employees and the ___________________________ from any and all liability, damage, claim of any nature whatsoever arising out of or in any way related to my participation in this event, including any act or omission of any third party. 3. I understand that I must carry my own Accident and Medical Insurance and agree that I am responsible for all such expenses whatsoever. 4. I have read and understand the terms of this Agreement and Release and agree to all terms and conditions on behalf of myself, heirs, representatives, executors or administrators. I hereby certify that by my signature that I am physically fit and able to participate and I have taken such steps as I deem are appropriate to assure myself that I am fit and capable of such participation. 5. I further state that I am aware of all inherent dangers of participation and risks involved in the activity, and I assume full responsibility for myself for bodily injury, death, and loss of personal property and expenses thereof as a result of those inherent risks and dangers and my negligence in participating in this activity. 6. I further acknowledge that travel to ______________________________ from San Antonio, Texas may involve the use of private passenger vehicles not owned or controlled by the University of the Incarnate Word, and that I am of lawful age and legally competent to sign this affirmation and release, and that I have signed this document as my own free act. 7. I understand and agree that while participating in this event, I will abide by the guidelines set forth in the University of the Incarnate Word Student Code of Conduct. Participant signature:____________________________________ Date: _________________ Social Security Number: ___________________________________ Witness signature: ______________________________________ If I am under the age of eighteen, I have read, understood an discussed with my parent or guardian identified below and we hereby accept the terms an conditions stated in this Hold Harmless Release Agreement. Participant's signature:_______________________________________________ Parent/Guardian's signature:___________________________________________ Emergency Information Person(s) to contact in case of emergency: __________________________________________ Phone Number: __________________________ Health Insurance company and policy number: _____________________________________