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Service-Learning Liability Waiver& Talent Release

 

PARTICIPANT’S NAME:  __________________________________________________________

                                                                                 (Please Print)

SERVICE-LEARNING PROGRAM TITLE:  ______________________________________________

 

COLLEGE OR UNIVERSITY:___Northwestern State University of Louisiana __________________

 

PARTICIPATING AGENCY: _________________________________________________________

 

Liability Waiver

As a service learner, I am providing community services as part of my coursework and not as an agent of Northwestern State University of Louisiana, who holds no responsibility and liability for me while I am engaged in this activity. 

 

I voluntarily and knowingly assume any risk associated with the service program and waive my right to assert any claim against the participating agency or any of its officers, agents, servants, employees and volunteers for injury, death or damage to my person or property resulting from my participation in this activity.

 

I release and hold harmless Northwestern State University of Louisiana, the State of Louisiana, all State Departments, Agencies, Boards and Commissions, as well as its officers, agents, servants, employees and volunteers, from any and all claims, demands, causes of action, expense and liability arising out of injury, death or damage to my person or property while participating in this activity.

 

Talent Release

I confirm that any and all material furnished and/or performed by me for the above titled activity is either my own or otherwise authorized for such use without obligation to me or to any third party. I also agree to the use of my name, likeness, portrait or pictures, writing, voice, performance, and biographical material about me for academic and program-related promotional purposes.

 

I hereby waive any claim to the rights of photographs or recordings made of me during this activity. I hereby authorize the editing, duplication, reproduction, copyright, exhibition, broadcast and/or non-profit use and distribution of said recordings for purposes deemed suitable by the University. I hereby waive any right to approve the finished products.

 

Northwestern State University of Louisiana and the UL System reserves full distribution rights to its program and all related materials, through any and all forms of duplication, both in the United States and all foreign markets.

 

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Signature of Participant (if 18 years of age or older)                                                         Date

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Signature of Participant’s Parent/Representative (if under 18 years of age)          Date