SCHOOLS ONLY

UNIVERSITY OF COUGARS FOR KIDS RELEASE AND INDEMNIFICATION AGREEMENT

PARTICIPANT: (Name and Address) INSTITUTION:

DESCRIPTION OF ACTIVITY: Traveling to and from ______[insert name of school] (the “Facility”), located in the , , area and performing volunteer work with children who are students at the Facility as part of Cougars for Kids.

LOCATION: , Houston, Texas

DATE:

I, the above-named Participant, am eighteen years of age or older and have voluntarily applied to participate in the Activity. I acknowledge that the nature of the Activity may expose me to hazards or risks that may result in my illness, personal injury, or death, and I understand and appreciate the nature of such hazards and risks. Such risks include, but are not limited to, illness, property damage, personal injury, or death that is caused from traveling to and from the Facility, participating in volunteer work in an elementary or similar school setting, and being exposed to educational professionals and students with illnesses. I understand that the University of Houston may not maintain or possess any insurance policies covering my participation or any circumstances arising from my participation in the Activity or any activity or event in any way associated with or facilitating that participation. As such, if I intend to drive to/from the Facility, I understand and agree that I should and will maintain proper and sufficient automobile/liability insurance to cover any acts or omissions on my part at any time during my travel to/from the Facility in connection with my participation in the Activity. I also understand and agree that I should and will maintain a proper and sufficient driver’s license. I represent that I am physically able, with or without accommodation, to participate in the Activity, and I am able both legally and physically to use any equipment and/or supplies associated with the Activity. I further understand and agree that I may be required to submit to certain tests (i.e. a background check) in connection with participation in the Activity.

In consideration of my participation in the Activity, I hereby accept all risks to my health and of injury or death that may result from such participation, and I hereby release the above named Institution (the University of Houston), its governing board, officers, employees, faculty members and representatives from any and all liability to me, my personal representatives, estate, heirs, next of kin, and assignees for any and all claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my participation in the Activity, whether caused by negligence of the Institution, its governing board, officers, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless the Institution and its governing board, officers, employees, faculty members and representatives from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act(s) or omission(s) while participating in the Activity and/or while participating in any non-Activity related activities or events.

I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND IT TO BE A RELEASE OF ALL CLAIMS AND CAUSES OF ACTION FOR MY INJURY, ILLNESS, OR DEATH OR DAMAGE TO MY PROPERTY THAT OCCURS WHILE PARTICIPATING IN THE ACTIVITY AND/OR WHILE PARTICIPATING IN ANY NON-ACTIVITY RELATED ACTIVITIES OR EVENTS, AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY, ILLNESS, OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT OR INTENTIONAL ACT(S) OR OMISSION(S).

Should I require emergency medical treatment as a result of accident or illness arising during the Activity, I consent to such treatment. I acknowledge that the University of Houston may not provide health and accident insurance for participants in the Activity, and I agree to be financially responsible for any medical bills incurred as a result of emergency medical treatment. I will notify University of Houston representatives in writing if I have medical conditions about which emergency medical personnel should be informed.

Signature of Participant Signature of Witness

Date Signed Date Signed

______Signature of Parent/Guardian (if participant is under 18)

______Date Signed

Note: Modification of this Form requires approval of OGC