St. Clair Athletics Liability Release

St. Clair College Athletics

Liability - Release Indemnity Form

***I wish to decline the transportation provided by St. Clair College and request permisson to travel on my own.

Have you requested permission from your Head Coach not to use the transportation provided and be absent from the team? *

Yes

No

First Name: *

Last Name: *

Student #: *

Cell Phone: *

Email: *

Varsity Team: *

Date of Travel: *

*

To

From

To & From

Location: *

School: *

Will I be travelling on my own? *

Yes

No

If the answer above is NO then who will be providing your transportation?

What is the reason you cannot use the transportation provided by St. Clair College? *

What date will you be returning to Windsor? *

I am 18 years of age. (If you are under the age of majority (18 years of age) then parental consent is required). *

I hereby release St. Clair College, its Board of Governors, Agents, Officers and Employees including Coaches from any liability with respect to any damage or injury that I may suffer as a result of my decision to depart from the team in the manner listed above.

I accept responsibility for my decision and actions absolving St. Clair College from any responsibility from the time I leave the team.

By clicking here I consent to the information above as correct and sign-off electronically. *

Signature Sign-off