Release of Liability and Waiver

    I, the undersigned student and, if applicable, the undersigned parent or guardian, agree and state as follows:
    1.    I have applied for and been awarded the Patched Overalls Scholarship for the ____________ academic year.
    2.    As part of my participation in the Patched Overalls Scholarship (d/b/a "The Patched Overalls Experience"), I expect to travel and undertake a variety of other activities, some of which may subject me to physical injury, inconvenience, economic expense and other potential hazards.
    3.    The particular travel and activities which I will undertake as a recipient of the Patched Overalls Scholarship are entirely of my own choosing and have not been determined or prescribed by the Patched Overalls Scholarship Board of Directors or by any individual involved with the Patched Overalls Scholarship project.
    4.    I undertake any and all travel or other activities associated with the Patched Overalls Scholarship voluntarily and of my own free will.
    5.    I hereby waive, release, and forever discharge Tyson P. Schaffner, Patched Overalls Scholarship Non-Profit Corporation, the Board of Directors of the Patched Overalls Scholarship Non-Profit Corporation, any and all officers, employees, agents, volunteers, judges, or any other individuals associated in any way with the Patched Overalls Scholarship or the Patched Overalls Scholarship Non-Profit Corporation from any and all liability for any and all claims and demands, rights and causes of action, whether presently known or unknown, because of personal injury, death, property damage, theft, lost wages, inconvenience or disability of any kind which may occur to me in the course of or arising in any way out of the travel or other activities I undertake as a recipient of the Patched Overalls Scholarship.    
    6.    I hereby agree to indemnify, defend, and hold harmless, the entities and persons listed in paragraph 5, above, from any and all liability or claims asserted by third parties or entities as a result of my participation in the Patched Overalls Scholarship program, including any resulting travel or other activity, whether resulting from my negligence or otherwise.
    7.    I understand that neither the Patched Overalls Scholarship Non-Profit Corporation nor any of the other individuals or entities listed in paragraph 5, above, are providing me with any insurance under any policy covering me for any injury, property damage, any economic loss or any inconvenience or other potential claim that may result from or arise in the course of any travel or other activities I undertake as a result of my participation in the Patched Overalls Scholarship project.
    8.    I understand that the terms of this release of liability and waiver shall be interpreted and enforced in accordance with the laws of the State of Missouri.
    I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN AND ENTER INTO IT OF MY OWN FREE WILL.

                                                    
                        Student Signature
__________________________________

                                                    
                        Print Student’s Name
__________________________________

                                                    
                        Date of Birth
__________________________________

                                                    
                        Student’s Parent or Guardian Signature and Printed Name (If under 18 years old)

                         ____________________________________________________________________________________________________

                                                    
                        Date __________________________________
                

 

 

Click here to download The Release of Liability and Wavier Form

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