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CENTER FOR SERVICE LEARNING AND CIVIC ENGAGEMENT
RELEASE/HOLD HARMLESS AGREEMENT
The undersigned does hereby acknowledge that there are risks of physical harm and injury inherent in
service activities including but not limited to, working with people, participating in sports and recreation
activities, cleaning and maintenance projects, preparing and serving food, and other service activities,
and in transportation to and from service work sites. As partial consideration of being allowed to
participate in this activity with Southwest Tennessee Community College and Southwest Tennessee
Community College Office of Service-Learning and Civic Engagement, I hereby assume all risk in the
travel activity and connected activities and hereby knowingly and intentionally waive any and all claims,
of whatsoever kind or nature, against such institutions which may arise out of this activity.
I assure officials of the Institution that there are no health-related or other reasons or problems which
preclude or restrict my participation in this activity. I assure officials of the Institution that I have
adequate health insurance necessary to provide for and pay any medical costs that may directly or
indirectly result from my participation in this activity and that I will indemnify and hold the institution
harmless.
I specifically acknowledge that in performing these activities, I am doing so in the status of a
server/volunteer for the community agency, and not a server/volunteer, employee or agent of
Southwest Tennessee Community College or the Southwest Tennessee Community College Office of
Service-Learning and Civic Engagement. I further waive any and all claims which may arise from such
service activities, acknowledge that workers compensation benefits are not extended to me in my
capacity as a server/volunteer and hold Southwest Tennessee Community College or the Southwest
Tennessee Community College Office of Service-Learning and Civic Engagement harmless from any of
my negligent acts. I further state that I am not in any way an employee of Southwest Tennessee
Community College or the Southwest Tennessee Community College Office of Service-Learning in any
capacity.
In consideration of the State of Tennessee, the Tennessee Board of Regents, Southwest Tennessee
Community College, and the Southwest Tennessee Community College Office of Service-Learning and
Civic Engagement, the undersigned does for himself, his heirs, executors, successors, and assigns,
release, waive, discharge, and covenant not to sue the State of Tennessee, the Tennessee Board of
Regents, or Southwest Tennessee Community College, its employees, agents, successors, and
assigns, or and from any and all actions, cause of action, claims, demands, damages, costs, loss of
service, expenses and compensation arising out of, on account of, related to, or in any way connected
with the undersigned’s participation in this activity and related activities. The undersigned agrees to all
Rules and Regulations set forth by the State of Tennessee, the Tennessee Board of Regents,
Southwest Tennessee Community College, and the Southwest Tennessee Community College Office
of Service-Learning and Civic Engagement.
THIS IS A RELEASE. READ BEFORE SIGNING.
IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT, I have read the foregoing
Waiver of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free
act and deed; no oral representations, statements, or inducements apart from the foregoing written
agreement have been made; I am at least eighteen (18) years of age and fully competent; and I
execute the Release for full, adequate and complete consideration fully intending to be bound by the
same.
IN WITNESS WHEREOF, I have hereunto set my hand on this ____ day of _______________, 20
____.
__________________________________ ______________________________
Name of Student (Print) Witness
__________________________________ _______________________________
Signature of Student Date
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