Student Indemnification Undertaking Form
Please read and acknowledge this undertaking to confirm your responsibility and indemnification for participating in the specified school or university activity.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Activity or Event Name
*
Date of Activity or Event
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Indemnification Undertaking Declaration: By signing below, I acknowledge that I am voluntarily participating in the above-named school or university activity. I accept full responsibility for my actions and any consequences arising from my participation. I agree to indemnify and hold harmless the institution, its staff, and representatives from any claims, liabilities, or damages resulting from my involvement in this activity.
Signature
*
Date Signed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Undertaking
Submit Undertaking
Should be Empty: