Astronomy 110 Laboratory: Release Form

Spring 2004 Astronomy 110L Thurs. 7:00 - 10:00 pm



ASSUMPTION OF RISK AND RELEASE

I, the undersigned, in full recognition and appreciation of the dangers and hazards inherent in class field trips, to which I may be exposed during my enrollment in Astronomy 110L, Spring semester, 2004, do hereby agree to assume all risks and responsibilities surrounding my participation in such field trips or any independent research activities undertaken as an adjunct thereto; furthermore, I do for myself, my heirs, executors, and administrators hearby remise, release, and forever discharge the University and all of its officers, agents, and employees, acting officially or otherwise, from any and all claims, demands, and actions, or cause of action, on account of damage to my personal property, or personal injury which may result from any cause during the participation of aforesaid.

IN WITNESS THEREOF, I have caused this release to be executed this ____________ day of ________________, 2003.


__________________________________________________
(Signature)

__________________________________________________
(Print name)

__________________________________________________
(Cosignature of parent or guardian if
student is under 18 years of age)



Donald L. Mickey (mickey@ifa.hawaii.edu)

Last modified: January 14, 2004
http://www.ifa.hawaii.edu/~mickey/ASTR110L_F03/release.html