Informed Consent and Assumption of Risk Form - Trinity University

Trinity University’s Informed Consent and Assumption of Risk Form – Fact Sheet
Generally, TU does not ask students to sign waivers or releases for programs/trips that are
required as part of a course or required in support of their academic work. It is, however,
important that students be informed of the dangers they may face while participating in these
programs/trips. It is required that all students sign an Informed Consent and Assumption of
Risk Form before participating in the trip, to establish their participation and to establish that
they have been fully warned of the dangers, and are aware of their responsibility for their own
safety. This form does not have the student waive his/her right to recover for losses caused by
negligence, gross negligence or intentional misconduct of the University or its employees.
Informed Consent and Assumption of Risk Forms must be specific to each trip. There are no
generic forms. Some classes may take frequent trips, such as a geology class. In such cases,
an informed consent form about class activities may be appropriate in lieu of a form per trip.
This form is designed to answer the most frequently asked questions regarding liability,
insurance and risk management issues around field trips, class trips, intern or practicum
placements. It is also designed to facilitate your communications with your students before you
go off campus and to give you tools to help you make the off campus experience safer for all
participants.
The form is available in a downloadable format via the TU Risk Management website at
http://www.trinity.edu/departments/fiscal_affairs/fapolicy/riskmgmt/specenvt.htm#PL1. If you
have any questions regarding this material or need any assistance, please contact the Risk
Management Office at extension 7306.
• This form requires that you specify the risks specific to your planned off campus trip on the
portion of the form designated (Specific dangers endemic in this Program’s area of travel or
endemic to the Program.) You can obtain additional risk management information for planning
trips via TU website at:
http://www.trinity.edu/departments/fiscal_affairs/fapolicy/riskmgmt/specenvt.htm#PL1.
• If you assign the practicum or internship site, contact the site coordinator to find out if he/she is
aware of criminal activity in their facility or in the parking lots adjacent to the facility. If there is
criminal activity, you must include this information in the Specific Dangers portion of the form.
• You may duplex this form but do not reduce in size.
• Instruct students/participants to report all accidents and injuries to you immediately, as soon as
it is safe to do so. Contact information: (1) Faculty/Staff coordinating activity; (2) Campus
Safety at 210-999-7070; and (3) Office of Fiscal Affairs at 210-999-7306.
• You may use a range of dates as long as you give detailed activity description.
• Students under the age of eighteen must have form signed by parent or legal guardian.
• Retain this form in your file for three years (seven years if the student is 18 years old) from the
date of the activity. If an accident or injury occurs, please contact Risk Management at extension
7306.
• Campus Safety has emergency contact information for accidents occurring after work hours or on
weekends. Students should be provided with this emergency contact information.
• Do not use this form for international travel study programs, activities other than for-credit
courses, conferences or athletic activities. Contact Risk Management for forms appropriate for
these activities.

TRINITY UNIVERSITY
INFORMED CONSENT AND ASSUMPTION OF RISK
Trinity University is a non-profit educational institution. References to Trinity University include
“TU”, its trustees, officers, officials, employees, volunteers, students, agents, and assigns.
• (Name)_____________________________________ (henceforth referred to as
“Participant”) will participate in: _____________________________________________
(henceforth referred to as the Program), from [specify dates];_____________________.
In consideration of my/my minor child’s enrollment in this Program, I agree as follows:
SPECIFIC HAZARDS OF TRAVEL OR PROGRAM: Despite precautions, accidents and
injuries can occur. I understand that traveling, doing fieldwork or being in a large city may be
potentially dangerous, and that Participant may be injured and/or lose or damage personal
property as a result of participating in the Program. Therefore, PARTICIPANT ASSUMES ALL
RISKS RELATED TO THE ACTIVITIES EXCEPT FOR RISKS CAUSED BY TU’S NEGLIGENCE,
GROSS NEGLIGENCE OR INTENTIONAL MISCONDUCT. These risks include, but are not limited
to:
• Death, injury or illness from accidents of any nature whatsoever, including, but not
limited to, bodily injury of any nature, whether severe or not, which may occur as a
result of participating in an activity or contact with physical surroundings or other
persons; arising from travel by car, bus or any other means; death, injury or illness
including food poisoning arising from the provision of food or beverage by restaurants or
other service providers.
• Theft, loss or damage of personal property while in transit or participating in the
Program.
• Natural disaster or other disturbances, and alteration or cancellation of the Program due
to such causes.
• Most trips to hospitals, schools and community service centers require travel through or
parking in high crime areas. Please review the attached safety guidelines.
• Listed below are specific dangers endemic in this Program’s area of travel or endemic to
the Program.
• I fully understand and appreciate the dangers, hazards and risks inherent in
participating in the Program, in the transportation to and from the Program, and in any
independent research or activities undertaken while participating in the Program.
• I agree that participating in any activity is an acceptance of some risk of injury and/or
loss or damage of property. I agree that Participant’s safety is primarily dependent upon
his/her taking proper care of himself/herself. I understand that is Participant’s

esponsibility to know what is needed for the Program and to provide what is needed, to
the extent it is not provided by the Program. I agree to make sure that Participant
knows how to safely participate in any activities. Participant agrees to observe any rules
and practices, which may be employed to minimize the risk of injury. Participant agrees
to stop and seek assistance if he/she does not believe that he/she can safely continue
any activity. Participant will not wear or use or do anything that would pose a hazard to
myself, or others, including using or ingesting any substance which could pose a hazard
to myself or others. I agree that if I/Participant does not act in accordance with this
agreement, I/Participant may not be permitted to continue to participate in the Program.
INSTITUTIONAL ARRANGEMENTS: I understand that TU is not an agent of, and has no
responsibility for, any third party which may provide any services including food, lodging, travel,
or other goods or services associated with the Program. I understand that TU may provide
these services only as a convenience to participants and that accordingly, TU accepts no
responsibility, in whole or in part, for delays, loss, damage or injury to persons or property
whatsoever, caused to Participant, while traveling or while staying in designated lodging. I
further understand that TU is not responsible for matters that are beyond its control. I
acknowledge that TU reserves the right to cancel the trip without penalty or to make any
modifications to the itinerary and/or academic program as deemed necessary by TU.
INDEPENDENT ACTIVITY: I understand that TU is not responsible for any loss or damage
Participant may suffer when traveling independently or otherwise separated or absent from any
TU activity. In addition, I understand that any travel that Participant does independently before
or after the TU sponsored Program is entirely at Participant’s own expense and risk.
I, individually, (and where applicable on behalf of my minor child, Participant,) and on behalf of
my heirs, successors, assigns and personal representatives, hereby RELEASE and FOREVER
DISCHARGE Trinity University, its employees, agents, officers, trustees, contractors and
representatives (in their official and individual capacities) from any and all liability whatsoever
for any and all damages, losses or injuries (including death) sustained to my (or my minor
child’s) person or property or both, including but not limited to any claims, demands, actions,
causes of action, judgments, damages, expenses and costs, including attorneys’ fees, which
arise out of, result from, occur during or are connected in any manner with Participant’s
independent travel, and any non-course required activities, excursions, side trips or field trips in
which Participant voluntarily undertakes while enrolled in the Program.
HEALTH AND SAFETY: Participant is hereby advised to consult with a medical doctor with
regard to Participant’s personal medical needs. I state that there are no health-related reasons
or problems that preclude or restrict Participant from participating in this Program. Participant
has obtained the required immunizations, if any. I understand and agree that TU is not
obligated to attend to any of Participant’s medical or medication needs, and I assume all risk
and responsibility. I agree to pay all expenses relating thereto.
TU RULES, REGULATIONS AND POLICIES: Participant agrees to obey and comply at all
times with all of the rules, regulations, codes and policies of TU while participating in the
Program. Participant agrees to notify his/her professor immediately of any injury or loss.
TRAVEL CHANGES: If, as a result of Participant’s own actions, Participant becomes separated
from the Program group, fails to meet a departure airplane, bus, or train, Participant will, to a
reasonable extent, and at his/her own expense seek out, contact, and reach the Program group
at its next available destination.

GOVERNING LAW; ENTIRE AGREEMENT I agree that this Agreement shall be construed in
accordance with the laws of the State of Texas, which shall be the forum for any dispute
concerning liability arising from Participant’s participation in the Program. This Agreement
represents my complete understanding with TU concerning TU’s responsibility and liability for
participation in the Program. This Agreement supersedes any previous or contemporaneous
understandings I may have had with TU on this subject, whether written or oral.
SIGNATURE: I indicate that by my signature below that I have read the terms and conditions
of participation and agree I/my minor child shall abide by them. I have carefully read this
Informed Consent and Assumption of Risk Form and acknowledge that I understand it. My
signature below indicates that I have read and freely signed this agreement, which take effect
as a sealed instrument.
Date: _________________________
_______________________________________
(Signature)
______________________________________
(Printed Name of Participant)
Signature of Parent/Guardian for Participants Who Are Minors:
I certify that I have custody of Participant or am the legal guardian of Participant by court
order. I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND AND AGREE TO ITS TERMS.
I AM AWARE THAT THIS AGREEMENT INCLUDES A RELEASE AND WAIVER OF
LIABILITY AND AN ASSUMPTION OF RISK.
Date: _______________________
______________________________________
(Signature of Parent or Guardian)
Received by:
Date: ________________________
_______________________________________
(Printed Name of Parent or Guardian)
_______________________________________
(Signature)
_______________________________________
(Printed Name of Institution Official)
________________________________________________________________________________________________________

List the activities/trips that you desire to participate in below, and submit with your signed
Informed Consent and Assumption of Risk Form.
•
DATE OF
ACTIVITY
FIELD TRIP ACTIVITY COURSE NO. INSTRUCTOR

Safety Guidelines
__________________________________________________________________
Suggestions For Your Safety Off-Campus…
Walking to and from your car…
• Have entry/ignition keys in hand before starting for your car so you’re not trying to find
them while you walk to the car or standing at the car door.
• Stay alert when crossing the parking lot and watch for suspicious persons.
• If you have a cell phone, have it within easy reach
• Even if your car was locked when you left it, check the interior prior to entry for
uninvited guests.
• If a stranger approaches you, continue walking to your car, politely decline requests for
money or information. Don’t stop walking toward your car.
• If asked for help, offer to call the police or suggest they return to the business. DO NOT
offer assistance yourself or allow a stranger to use your cell phone.
• If a situation seems suspicious, look for someone to help you or dial 9-1-1.
While driving…
• Follow established roadways. Use familiar streets, not back roads or “shortcuts”.
• Make sure all doors are locked while driving.
• Put purses and/or other valuables out of sight, if possible, or cover item(s) with a towel.
• Stay alert at stop signs and traffic lights. If a stranger approaches your car at a traffic
light, drive away.
• Don’t leave your car’s engine running while you’re out of or away from the car.
• If your car breaks down or you have a flat, call for assistance from within your (locked)
car and remain inside until help arrives.
• Don’t travel to remote areas by yourself.
• Be sure you have plenty of gas before you start a trip.
• Plan your route. Get driving directions from the Internet if necessary.
If you should become involved in an accident:
• At night, drive (if possible) to a lighted area.
• If the occupants of the other car make you uncomfortable, call the police from
within your (locked) car and remain inside until the police arrive.
• Jot down the description and license number of the other car while you wait for
the police.