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College and Career Lab: Acknowledgement of Risk and Release and Waiver of Liability Form

All participants are required to have a completed Acknowledgement of Risk and Release and Waiver Form on file. Participants who are under 18 years of age must have this form completed by a parent or legal guardian.

Please note that all fields are required.
Student Information
Acknowledgement of Risk and Release and Waiver of Liability
As parent or legal guardian of the child whose name appears above, I acknowledge that there are certain risks inherent in my child’s participation in a program at NYU, which will take place during the 2021-2022 academic year. These risks include, without limitation, risks associated with travel to, from, and in and around New York City and my child’s participation in supervised and unsupervised activities while at NYU in person or online. I also acknowledge that any questions I or my child have about activities or travel related to their NYU program(s) can be addressed to representatives of New York University (the “University”). I agree that I will inform an appropriate representative of the University of any special information regarding the health, or physical or mental condition of my child that may be relevant to my child’s participation in their NYU program(s).

In consideration for permitting my child to participate in a program at NYU, I hereby agree: (a) to release and discharge the University from any liability or responsibility for any personal or bodily injury (including death), and for any damage to or loss of property, however caused, that my child or I suffer as a result of or in connection with my child’s participation in their NYU program(s) or any travel related to their program(s), including, without being limited to, any injury, loss, or damage resulting from, arising out of, or occurring in connection with the negligent acts or omissions of members of the faculty or staff or other employees, agents or servants of the University; and

(b) not to raise any claim or institute any legal action or proceeding, on my behalf or on behalf of my child, against the University for any cause of action that may result from or arise out of or in connection with my child’s participation in their NYU program(s) or any travel related to their program(s), for any personal or bodily injury (including death) to my child, including, without being limited to, injury, loss, or damage that may result from or arise out of or in connection with the negligent acts or omissions of members of the faculty or staff or other employees, agents or servants of the University.

All references to the University in this form will include, and all provisions of this form will inure to the benefit of, the University’s trustees, officers, employees, agents, servants, and representatives. This acknowledgment of risk and release and waiver of liability are governed by and will be construed in accordance with the laws of the State of New York without regard to principles of conflicts of law. I agree that I will submit to the exclusive jurisdiction of the federal and state courts located in New York County, New York State, for the resolution of all disputes arising hereunder or relating hereto, regardless of the place of execution of this form.
Parent/Legal Guardian Signature
This section must be completed by a parent or legal guardian.
I agree that any electronic signatures appearing on this Agreement or such other documents are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.
I agree that any electronic signatures appearing on this Agreement or such other documents are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.
Date
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