(to be completed by the student)
The undersigned, being over the age of eighteen years or in the capacity of legal guardian for a person identified below, does hereby acknowledge that there are risks of physical harms and injury inherent in service activities, including, but not limited to, working with people, participating in sports and recreational activities, cleaning and maintenance projects, preparing and serving food, and other service activities, and in transportation to and from service work sites. As partial consideration of being allowed to participate in this activity associated with Fullerton College and the North Orange County Community College District, I hereby assume all risks inherent in the travel activity and connected activities and hereby knowingly and intentionally waive any all claims of whatsoever kind 9or nature against such institutions which may arise out of this activity.
I specifically acknowledge that in performing these activities, I am doing so in the status of a server/volunteer of the service that I choose, and not a server/volunteer, employee, or agent of Fullerton College or the North Orange County Community College District. I further waive any and all claims which may arise from such service activities, acknowledge that worker’s compensation benefits are not extended to me in my capacity as a server/volunteer and hold Fullerton College and the North Orange County Community College District harmless from any of my negligent acts. I further state that I am not a full-time employee of the North Orange County Community College District.
I specifically grant this waiver of claims for myself and/or on behalf of my ward identified below and will indemnify and hold harmless such institutions and individuals from any claims.
Done, this ____________________ day of __________________, 20___ on behalf of myself, my heirs, devisees, legatees and estate (and on behalf of my legal ward named _______________________________ - for students under 18 years of age).
Printed name _________________________________________
Emergency Phone Number _______________________________