HTML Preview Travel Release Form page number 1.
TRAVEL RELEASE FORM
NAME:
STUDENT □
STAFF
□ TRAINER □
OTHER
I am a member of the Men’s / Women’s (circle one)
team / group at
Western University. I will not be traveling with the team / group To / From (circle one or both)
the competition / event at _(location) on (date(s)).
I assume full responsibility in making alternative travel arrangements. Western University has offered to
provide me transportation to and from the competition / event, but I refuse this offer and agree to accept
all risks of personal injury which may result from my decision to use alternative arrangements.
I understand that Western University, the department of Sports and Recreation Services and its affiliates
are not responsible for any injury or accident that may occur. Furthermore, I assume responsibility for all
of my actions and activities before I join or once I leave the company of the team / group.
Signature Date
Coach / Group Leader Signature Date
**Please file this form with the Travel Coordinator (WSRC 3235) before departure of noted trip.
Western University
Sports and Recreation Services, WSRC 3235
London, Ontario, CANADA, N6A 5B9
Telephone: (519) 661-3552, Facsimile: (519) 661-3385
E-mail: [email protected] Website: www.westernmustangs.ca