* 1. Name

* 2. Email

* 3. Phone Number


This Release and Waiver of Liability (the “Release”) is executed in favor of Barry University, its affiliated organizations, directors, officers, employees, students, and agents, and their successors and assigns (hereinafter referred to jointly as “Barry”). I desire to engage in a student trip to Oleta River State Park (“Student Trip”) on April 6, 2014 . I acknowledge that I am not obligated to participate in this Student Trip and that it is purely voluntary. I hereby freely and voluntarily, without duress, execute this Release under the following terms.
A. I release and forever discharge and hold harmless Barry from any and all liability, claims, and demands of whatever kind or nature, either in law or in equity, which arise or may hereafter arise from my participating in this Student Trip and related activities, whether such liability, claims, or demands result from travel, participating in the rally, disease, consumption of food, or from civil unrest or otherwise.
B. I understand and acknowledge that this Release discharges Barry from any liability or claim against it, including any negligence by Barry, with respect to any bodily injury, personal injury, illness, death, monetary loss or property damage that may result from my participation in this Student Trip. I understand that Barry assumes no responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance, in the event of injury, illness, death, accident, monetary loss or property damage.
C. I hereby release and forever discharge Barry from any claim whatsoever which arises or may hereafter arise on account of any first-aid treatment or other medical services rendered to me or to my dependent/companions in connection with an emergency or health problem during my participation in the Student Trip. I understand that my participation in this Student Trip may include activities and circumstances that may be hazardous to me, including, but not limited to travel, local transportation in the city to which I travel, poor health conditions, inadequate medical treatment facilities and other inherent dangers. I recognize that I may be traveling to and from locations that pose risks from terrorism or criminal activities.
D. I hereby expressly and specifically assume the risk of injury, illness, death, monetary loss or property damage resulting from such circumstances during my participation with this Student Trip, whether suffered by me personally or by any of my accompanying dependents or companions.
E. I understand that should I not be present at the appointed time of departure, Barry is not responsible for my transportation back to campus (or anywhere else) or the cost of said transportation.
E. I agree that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the remaining provisions of this Release which shall continue to be enforceable. I understand that any dispute concerning this Release which shall continue to be enforceable.
F. I understand that any dispute concerning this Release or any aspect of my participation in this Student Trip shall be brought only in the state or federal courts in Miami-Dade or Broward County, Florida. I specifically waive any jury trial for any lawsuit brought as a result of this Release or this Student Trip.

* 5. Emergency Contact

* 6. Emergency Contact Information

* 7. Insurance Company

* 8. Policy Number