The following form should be submitted by every individual going on the trip. This form includes both, an emergency information form and a liability form. Additionally, you will need to fill out this form for every single trip that you attend with your club/organization.
Every effort is made to ensure the safety and well-being of students involved in student organizations, but sometimes emergencies do occur. By completing this form, you ensure that if you are ever involved in an emergency, your information will be accurately conveyed to health professionals caring for you. Please accurately and truthfully complete the Emergency Information. THIS INFORMATION WILL REMAIN CONFIDENTIAL.
All students that participate in an event with their club and/or student organization must fill out this form. It is to be filled out for each event that is held by your student organization. This form must be submitted in to the Student Activities Office at least one week prior to dates of the event.
I am 18 years of age. I have consulted with persons that I have chosen concerning the dangers and risks inherent in the activity/event as listed above. I am familiar with the hazards of the activity/event listed above. I understand the dangers of such activity and any necessary travel involved.
I agree to exercise necessary caution and to obey the safety instructions of the campus advisors and student leaders involved. I agree that neither the student organization; Drury University; the City of Springfield nor their agents, servants or employees assumes any custodial responsibility or liability for me (except to the extent of coverage afforded by any applicable automobile liability insurance or vehicles owned by or leased to the university).
I hereby unconditionally release and absolve Drury University, all campus advisors, student leaders and any servants, agents, employees, instructors, sponsors or leaders involved in this experience from liability for any accident or injury.
I hereby agree to indemnity and save harmless Drury University and its directors, officers, employees, and agents (1) from and against any claims or liabilities, asserted or recovered on my behalf, and from any third party claims or liabilities arising from injuries to me or my property, or to third persons, or the undersigned whether or not intentional or resulting in death, caused in whole or part by me alone or in association with others; (2) from and against any claim or liability arising out of the selection or authorization for treatment of medical doctor, hospital treatment (including surgery) or on account of any financial obligations incurred by the undersigned student.
In case of an emergency, I understand that every effort will be made to secure proper treatment. I hereby give permission for such treatment. My personal health and accident insurance covers any accident or illness, which I may incur during this experience. I personally guarantee payment of any cost or other liability incurred during evacuation or treatment.
I have read this release prior to signing it, and I fully understand it. I understand that this document is legally binding. I know that this document binds me and all those claiming under, through, or on account of me.
This form must be submitted to the Student Activities Office at least one week prior to the date of the event.
