PALM Liability Release Form

COLLEGE OF CHARLESTON LIABILITY RELEASE,
EMERGENCY MEDICAL AUTHORIZATION AND AGREEMENT
(for activities that involve strenuous physical activities)

Instructor emails begin with their last name and first initial (found in previous box) and end with @cofc.edu.
  1. I, the undersigned student, desire to participate in the College of Charleston (“College”) course and associate activities related to that course listed above under "Name of Class," that requires some potential strenuous physical activity. I fully understand and appreciate the dangers, hazards, and risks inherent in the Activities, and can result in injury and impairment to my body, general health and well-being, and could include serious or even fatal injuries, illnesses or medical conditions.
  2. Knowing the dangers, hazards, and risks of such endeavors, and in consideration of being permitted to participate in the Activities, on behalf of myself, my family, spouse, heirs, and personal representative(s) (the “Releasors”), I agree to assume all the risks and responsibilities surrounding my participation in the Activities, the transportation to and from an Activity, and in any additional physical exertion or exercise or other acts undertaken as supplemental to any such Activity, and on behalf of myself and the Releasors I hereby release, waive, forever discharge, and covenant not to sue the State of South Carolina, the College of Charleston, and its trustees, officers, agents, employees and any students acting as employees (“Releasees”), from and against any and all liability and for any harm, injury, damage, claims, demands, actions, causes of action, costs, and expenses of any nature that I may have or that may hereafter accrue to me or a Releasor, arising out of or related to any loss, damage, or injury, including but not limited to suffering and death, that may be sustained by me, whether caused by the negligence or carelessness of the Releasees, or otherwise, while engaged in the Activities, any act supplemental to an Activity, or while I am in transit to or from the premises where an Activity or supplemental act occurs or is being conducted.
  3. I further agree to indemnify and hold harmless the Releasees from and against any loss, liability, damage or cost, including court costs and attorneys’ fees that may arise due to my participation in the Activities.
  4. It is my expressed intent that this LIABILITY RELEASE, EMERGENCY MEDICAL AUTHORIZATION. AND AGREEMENT (the “Agreement”) shall bind me, the members of my family and spouse, if I am alive, and my estate, family, heirs, administrators, personal representatives, or assigns, if I am deceased, and shall be deemed as a legally binding release, waiver, discharge and covenant not to sue the Releasees.
  5. I understand, agree and hereby grant Releasees permission to authorize emergency medical treatment for me, if necessary, and that such action by Releasees shall be subject to the terms of this Agreement. I understand and agree that Releasees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment.
  6. By digitally signing this Agreement, I acknowledge and represent that I have carefully read this Agreement and understand its contents and that I sign this document as my own free act and deed. I further state that I am at least eighteen (18) years of age and fully competent to sign this Agreement; and that I execute this Agreement for full, adequate, and complete consideration fully intending to be bound by the same. I further state that there are no health-related conditions, reasons or problems which preclude or restrict my participation in the Activity, that I consulted my primary healthcare provider regarding the same and have been approved to participate in the Activities by such provider, and that I have adequate health insurance necessary to provide for and pay any medical costs that may arise as a result of an injury to me. I recognize that the College of Charleston (“College”) is not obligated to provide for any of my medical or medication needs or insurance and that I assume all risk and responsibility for those needs.
  7. I further agree that this Agreement shall be construed in accordance with the laws of the State of South Carolina. If any term or provision of this Agreement shall be held illegal, unenforceable, or in conflict with any law governing this Agreement the validity of the remaining portions shall not be affected thereby.
  8. If I am an employee of the College, I do not consider the Activity within the course and scope of my employment with the College. By signing below I also agree to comply with the College’s Student Code of Conduct and all other College regulations regarding conduct, comportment, and academic integrity during my participation in the Activities. I understand that the College has the right to enforce such standards of conduct and that I may be dismissed from any or all Activities at any time for failing to abide by such standards.

By entering my CWID number below, I acknowledge that I have read and that I understand this LIABILITY RELEASE, EMERGENCY MEDICAL AUTHORIZATION AND AGREEMENT and, by entering my CWID, I am voluntarily digitally signing this document:

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