Transportation-Attendee – Associated Students

Associated Students’ Travel Services Questionnaire-Attendee

Use this form if you are an attendee of a travel related event.

Step 1 of 3

Name*
First Last
Email*
UCSB Perm #*
Entity Name*
Event Title*
Event Location*
Travel Start Date*
MM slash DD slash YYYY
Travel End Date*
MM slash DD slash YYYY
What is the nature of your travel (brief description)?*
Are you Driving Your Own Car?*
- Yes
- No
Driver's License Number
Car License Plate Number*
Insurance Company and Policy Number*
Name of A.S. Advisor*

Waiver of Liability, Assumption of Risk & Indemnity Agreement
University of California, Santa Barbara Elective/Voluntary Activities Waiver
Department*
Waiver: In consideration of being permitted to participate in any way in*
hereinafter called “The Activity”, I, for myself, my heirs, personal representative or assigns, do hereby release, waive, discharge, and covenant not to sue The Regents of the University of California, its officers, employees, and agents from liability from any and all claims including the negligence of The Regents of the University of California, its officers, employees and agents, resulting in personal injury, accidents, or illnesses (including death) and property loss arising from, but not limited to, participation in The Activity.

Assumption of Risks: Participation in The Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions 3) catastrophic injuries including paralysis and death.

I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in The Activity. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.

Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD The Regents of the University of California HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in The Activity and to reimburse them for any such expenses incurred.

Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
Participant Signature*
Date*
MM slash DD slash YYYY
Age*
Parent Signature
if participant is under 18 years of age
Name of Parent
First Last
Date
MM slash DD slash YYYY
Personal Emergency Contact Info: name, phone number, relation*
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Associated Students’ Travel Services Questionnaire-Attendee

Step 1 of 3

Waiver of Liability, Assumption of Risk & Indemnity Agreement