TRAC Release Form

1Release and Assumption of Risk Agreement > 2Photographic / Film Consent & Release Form
Name of person participating: Name of person participating: Title First Last Suffix
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What organization, class or school are you with?

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I, the undersigned, I, the undersigned, Title First Last Suffix
Please enter your name.
, of the following address, , of the following address,
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
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do agree, and promise the following for and in consideration of my participation in the Team Ropes Adventure Challenge (TRAC) offered by Florida International University (FIU or the University) to be held on this date and all activities related thereto (the Program). do agree, and promise the following for and in consideration of my participation in the Team Ropes Adventure Challenge (TRAC) offered by Florida International University (FIU or the University) to be held on this date and all activities related thereto (the Program). / MM / DD YYYY

Date of TRAC Session
I. My participation in the Program is voluntary because of the learning experiences I will gain. I understand that the Program includes navigating a network of ropes, beams, cables, swings, and/or pulleys some of which may be 25 to 40 feet above the ground, and kayaking and that the Program is set in out-of-doors surroundings and can also on the water. I understand that I choose at which level of physical difficulty. I represent that I have no medical condition that would prevent me from participating in the Program.

II. I acknowledge that FIU and their respective officers, employees, and agents are not responsible for losses or expenses suffered by me due to delays, changes in itinerary, changes in the content of Program, or other matters which are beyond their control.

III. I acknowledge that, in the course of my participation in the Program, I may be exposed to risks, some known and some unknown, which may result in property damage or loss, as well as personal or bodily injury which could be painful, permanently disfiguring, debilitating and even fatal. I voluntarily assume full responsibility for all such risks including, but not limited to, sickness, bad weather, broken bones, partial and/or total paralysis, other ailments that could cause serious disability, drowning, and/or death. I further expressly assume full responsibility for any risk of bodily injury, death, or property damage due to the negligence of the State of Florida, Florida Board of Governors, the FIU Board of Trustees, and/or FIU (collectively FIU) and their respective employees and agents, or otherwise.

IV. I, for myself, my heirs, personal representatives and assigns voluntarily agree to release, waive, discharge and relinquish and to indemnify and hold harmless FIU from and against all claims, suits, or causes of action for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise from my participation in the Program. I specifically understand that I am releasing, discharging, and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by FIU and their respective employees and agents, or otherwise. I agree that, under no circumstances, will I or anyone claiming through me, prosecute or present any claims for personal or bodily injury property damage or loss, or wrongful death against FIU and their respective employees and agents, or otherwise.

V. I further expressly agree that this Release and Assumption of Risk Agreement is intended to be as broad and as inclusive as the laws of the State of Florida will allow, and that if any portion thereof is held to be invalid, it is agreed that the balance shall, notwithstanding the invalid portion, will continue in full legal force and effect.
I HAVE READ THE ABOVE RELEASE AND ASSUMPTION OF RISK AGREEMENT AND, BY SIGNING IT, AGREE THAT IT IS MY INTENTION TO EXEMPT AND RELIEVE FIU FROM LIABILITY FOR PERSONAL LIABILITY, PROPERTY DAMAGE, OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE OF ACTION.

I have read and fully understand the terms of this release. I state, under penalty of perjury, that I am authorized to sign this release either for myself or on behalf of the person whose name appears below.
Signed and dated this day: Signed and dated this day: / MM / DD YYYY

Enter the date form is signed.
Signature:

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Print Name: Print Name: Title First Last Suffix
Print your signature name.
Phone: Phone: - ### - ### ####
E-Mail Address:

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*If the participant is under 18 years of age, the parent or guardian must sign on behalf of the participant and must complete the following representation:
I state that I am the legal guardian or parent of (name of child) I state that I am the legal guardian or parent of (name of child) Title First Last Suffix
(Participant)
I am signing to approve the Participant’s participation in the Program. By signing, I agree that the Participant and I are bound by the terms of this Release and Assumption of Risk Agreement.

TRAC Release Form

TRAC Release Form

*If the participant is under 18 years of age, the parent or guardian must sign on behalf of the participant and must complete the following representation:

I am signing to approve the Participant’s participation in the Program. By signing, I agree that the Participant and I are bound by the terms of this Release and Assumption of Risk Agreement.