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Clark College Acknowledgement of Risks

Event Title Water Quality Sampling Field Trip
Event Date Nov. 17, 2014- Nov. 17, 2014
Instructor Philip Jones
Course Biology (Life Sciences) 2128
Term Fall 2014
Date: Nov 19, 2017
Event Description:
Sampling macroinvertebrates as proxy indicators of water quality.
 
Student ID# - Numbers only, no dashes (Example: 9401234567)
Acknowledgement of Risks Form
This activity involves inherent risks of injury, and that the nature of the risks may vary depending upon the type of activity, instructor, and my own physical condition and conduct. I also understand that it is not possible to specifically list each and every individual risk.

Possible risks associated with this activity may include but are not limited to:
  • Exposure to allergens or pathogens
  • Accidents related to traffic/transportation
  • Animals
  • Sun and other elements
  • Acts of nature
  • Drowning

I acknowledge that I will either ask for or have been given any information that I need to determine the general risks associated with this course/activity. I recognize and acknowledge that there are both foreseeable and unforeseeable risks of injury or death.
I understand that certain precautions may be advised for the particular course/activity. I agree to follow those precautions and to conform to all rules and policies of the department, the instructor and any other sponsor of this course/activity. However, I recognize that these precautions will not eliminate the risks inherent in the course/activity.
I understand it is my responsibility to provide for my own medical and accident coverage. Clark College does not provide direct medical and accident coverage; however, persons (if eligible) may purchase such insurance coverage by contacting Health Services at 360-992-2264 or the Cashier's Office at 360-992-2177.
I voluntarily assume all risks of loss, damage, illness, or injury which I may sustain while participating in this course/activity, including travel and usage of any equipment or facilities.
I have informed my instructor in writing of any medical, physical, and or emotional concerns that I have regarding this activity.
If any portion of this Acknowledgement of Risk is determined to be invalid or unenforceable, the remaining parts or portions shall be enforceable.
I have carefully read this Acknowledgement of Risks and fully understand its contents. I am aware that this Acknowledgement of Risks is a contract between Clark College and myself and I sign it of my own free will.
If participant is under the age of 18, parent or guardian must complete the following:
I have read and understand the above information. I give my permission for my child to participate in this course/activity and grant the same informed consent and acknowledgement of risk on behalf of myself, my child and the child's family.
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