AGREEMENT

CONCERNING ASSUMPTION OF RISK,

RELEASE, AND MEDICAL CONSENT

DEPARTMENT OF BIOLOGY

GEORGE MASON UNIVERSITY

The following agreement is designed to familiarize and inform

participants in Biology courses requiring field work with the

possible hazards and risks involved in these courses. This

agreement is also designed to protect all participants in George

Mason University programs, including faculty members, George

Mason University, and the agencies and individuals cooperating

with the University. As a participant in these courses or

programs you must sign this form to indicate agreement and obtain

permission to participate.

1. Assumption of risk and general release.

I, ________________________________, understand that field work

involves some element or risk. Some of the dangers I may

encounter include, but are not limited to, the hazards of travel

to and from the field sites, including hiking and encounters with

poisonous plants, animals or fungi. I understand that

participation requires work out-or-doors, hiking in and out of

field sites etc. I understand that the university may provide

transportation to the field site. Furthermore, I understand that

I may choose to drive my own vehicle to local field sites, or

that I may choose to ride in a private automobile instead of the

vehicle provided by the university. In any and all cases,

however, I will not attempt to hold George Mason University, its

trustees, officers, employees, or agents liable in damages for

any injury, death, loss to person or property sustained by me

while participating in or arising out of my travel or activities

conducted by or under the auspices of George Mason University and

the Commonwealth of Virginia, except those injuries or deaths or

losses to person or property caused in whole or in part by

negligent acts, or omissions of agents and employees of the

Commonwealth of Virginia.

2. Insurance Coverage

I understand that the University requires that all students have

appropriate accident and medical insurance coverage, and that it

is my own financial responsibility to provide for medical

insurance and to pay any deductible expenses or any other of my

own medical expenses that are not covered by insurance.

I HAVE READ AN UNDERSTAND THE ABOVE PROVISIONS AND AGREE TO BE

BOUND BY THEM AS INDICATED BY MY SIGNATURE BELOW.

PRINTED STUDENT NAME STUDENT SIGNATURE

______________________ _____________________

STUDENT ID NUMBER DATE

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