Take Note

A Service of Lessons and Carols

Thurs., Nov. 30, 7:00 p.m., Ligon Chapel; free and open to the public

HLA Waiver Form

Huntingdon Leadership Academy: June 24–29, 2018

Each HLA participant must complete and submit the form below, including signatures by the student and by the student’s parent or guardian, prior to arrival for the Huntingdon Leadership Academy event.

Huntingdon Leadership Academy Waiver Form

  • mm/dd/yyyy
  • Name of Emergency Contact 1 * Required
  • Name of Emergency Contact 2 * Required
  • Huntingdon Leadership Academy Hold Harmless Agreement and Waiver Form

    I, the undersigned, for and in consideration of my participation in The Huntingdon Leadership Academy, in which I freely and voluntarily accept to participate, do hereby expressly agree and understand not to hold Huntingdon College, its Board of Trustees, officers, administrators, employees, representatives and/or agents, and their heirs, successors, and assigns, liable in any way whatsoever for any injury, or damage or loss of property sustained by me or persons other than myself, arising out of, or in connection with my participation in the aforementioned trip / activity. For the same consideration and without conflict with the foregoing, voluntarily and knowingly, I hereby release and discharge Huntingdon College, its Board of Trustees, administrators, employees, representatives and/or agents, and their heirs, successors, and assigns, both in their official and individual capacities, jointly and severally, from any actions, causes of action, claims, demands, damages, costs, and expenses on account of or in any way growing out of any and all loss of personal property, on injury, as the result of any accident, delay, irregularity which may be caused either in whole or in part by any defect in any vehicle, airplane, vessel, or operation thereof and through any act, error, or omission, or default of any company or person, or by reason of the conditions, use of any real or personal property while I am en route to, or from, or participating in the trip / activity occasioned by it. I further promise to bind myself, and all my heirs, administrators, and executors to indemnify and forever hold harmless Huntingdon College, its Board of Trustees, administrators, employees, and/or agents against loss, damage or expense from any and all claims, demands, actions or causes of action that may arise out of, because of, or relating to any occurrence while en route to, or from, or participating in the trip / activity relating to or occasioned by it. Moreover, I understand that all College policies are applicable while I am participating in a sponsored trip / activity. Any violation(s) of these policies may subject me to disciplinary action to include suspension/expulsion from the College. Destruction of public or private property, use of drugs (including alcohol), possession of a weapon, failure to adhere to directives from College representative, or behavior which is contrary to the tenet of common decency and respect for the rights and properties of others are examples of conduct subject to disciplinary action. Further, I may be held personally financially liable for any destructive or disruptive behavior by me which results in injury or destroys or damages property.
  • Health Care Authorization

    I hereby do state and understand that I may become ill and/or injured while participating in a Huntingdon College trip / activity, and through physical and/or mental incapacity, be unable to give my informed consent to a medical operation and/or procedure, if such medical operation and/or procedure be necessary in the opinion of the treating or consulting physician, then in that event, I do hereby authorize and empower the designated representative of Huntingdon College for the aforementioned trip/activity to give such informed consent for and on behalf of me and to authorize such medical operation and/or procedure as the treating or consulting medical personnel deems to be necessary under the prevailing circumstances. I do further release Huntingdon College, its Board of Trustees, administrators, employees, and/or agents against loss, damage or expense from any and all claims, demands, actions or causes of action that may arise out of, because of, or relating to the exercise of the authority granted herein. I expressly understand and agree that Huntingdon College, its Board of Trustees, administrators, employees, and/or agents assume no liability for any medical treatment rendered to me in conjunction with the event related to this form.
  • Signatures

    IN SIGNING THIS WAIVER OF LIABILITY/ASSUMPTION OF RELEASE FORM, I ACKNOWLEDGE AND REPRESENT THAT I HAVE READ IT IN ITS ENTIRETY, UNDERSTAND IT, AND VOLUNTARILY SIGN IT AS MY OWN FREE ACT AND DEED; THAT NO ORAL REPRESENTATIONS, STATEMENTS, OR INDUCEMENTS NOT CONTAINED IN THE FORM HAVE BEEN MADE TO ME BY ANY OF THE RELEASED PARTIES; AND THAT I EXECUTE THIS RELEASE FULLY INTENDING TO BE BOUND BY THE SAME.
  • By writing in your name, you are providing your official signature for this waiver form.
  • This is to certify that I, as parent/guardian with legal responsibilities for this participant, do consent and agree to the release as provided above of Huntingdon College, its Board of Trustees, administrators, employees, and/or agents, and, for myself, my heirs, assigns, and next of kin. I release and agree to indemnify and old harmless Huntingdon College, its Board of Trustees, administrators, employers, and/or agents from any and all liabilities incident to my minor child's involvement or participation in the Huntingdon Leadership Academy.