Any member of a scientific party enrolled in Status 4 or Status 5 on the Scientific Party List is required to complete a UCSD Waiver of Liability form. Please print, complete and sign this form, then mail it to:

 

Ship Scheduling Office

Scripps Institution of Oceanography, 0210

UC San Diego

9500 Gilman Drive

La Jolla, CA. 92093 - 0210

 

For Fed-Ex/Courier packages, please mail materials to this address:
Scripps Institution of Oceanography, UCSD
Administration Building, Rm. 108
8622 Discovery Way
La Jolla, CA 92037

 

A fax copy is acceptable provided it contains the required signature(s). Fax number is 858-822-5811.

 

Complete the form by filling in the scientific party member's (participant's) name, ship name, the cruise start and end dates, and signing/dating where indicated. For purposes of this form a "minor" is under age 18.

 

Please return waiver forms as far in advance of the cruise as possible, so that the ship can be informed which forms are in hand and if any must still be executed prior to sailing. Due to time zones and weekend/holiday hours forms sent to the Ship Scheduling Office very late may not be relayed to the ship prior to departure. This may delay departure and/or prevent the scientist involved from sailing.

 


 

 

Participant's Name: _______________________________

Please Print: _____________________________

 

 

UNIVERSITY OF CALIFORNIA, SAN DIEGO

 

Scientific Party Aboard Scripps Institution Research Vessel

 

Waiver of Liability, Assumption of Risk, and Indemnity Agreement

 

Name of Class or Activity____________________                                                

 

Waiver: In consideration of being permitted to participate in any way in:

Scientific Party on R/V _______________________from (date) ___________to (date)________

Hereinafter called "The Activity", I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue The Regents of the University of California, its officers, employees, and agents from liability from any and all claims resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in The Activity.

 

_______________________________________             ______________________________________

Signature of Participant & Date                                             Signature of Parent/Guardian of Minor & Date

 

Assumption of Risks: Participation in The Activity carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains to 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 3) catastrophic injuries including paralysis and death.

 

I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in The Activity I hereby assert that my participation is voluntary and that I knowingly assume all such risks.

 

Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD The Regents of the University of California HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney's fees brought as a result of my involvement in The Activity and to reimburse them for any such expenses incurred.

 

Severability:    The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

 

Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

 

_______________________________________             ______________________________________

Signature of Participant & Date                                             Signature of Parent/Guardian of Minor & Date

Participant's Age (if minor) _______________

 

Req waiver 04/05