The undersigned, the legal guardian of
a student at Dixie State University under eighteen years of age, in consideration of student’s participation in the course/program of
do hereby agree to this waiver and release.
I recognize that participation in this trip or activity may involve moderate to strenuous physical activity and may cause physical and or emotional distress to participants. There may also be associated health risks. I state that student is free from any known heart, respiratory or other health problems that could prevent student from safely participating in any of the activities.
I certify that I have medical insurance or otherwise agree to be personally responsible for costs of any emergency or other medical care that student receives. I agree to release State of Utah, DSU and their agencies, departments, officers, employees, agents, and all sponsors, officials and staff or volunteers from the cost of any medical care that student receives as a result of participation in
I further agree to release the State of Utah, DSU, their agencies, departments, officers, employees, agents and all sponsors, officials and staff or volunteers from any and all liability, claims, demands, breach of warranty, negligence, actions, and causes of actions whatsoever for any loss, claim, damage, injury, illness, attorney’s fees or harm of any kind or nature to me arising out of student’s participation in this DSU course/program. This release extends to any claim made by parents or guardians or their assigns arising from or in any way connected with the aforementioned activities.
Consent is expressly given, in the event of injury, for any emergency aid, anesthesia and / or operation, if in the opinion of the attending physician, such treatment is necessary.
I have carefully read and understand the contents of the foregoing language and I specifically intend it to cover student’s participation in the above stated field trip.