WAIVER & RELEASE OF LIABILITY: Moving & Storage of Student Possessions

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This form is to be completed by Dominican University of California students assigned to a residence hall space who are unable to return to campus to retrieve their personal possessions. Upon the student request, University personnel will pack and store student personal possessions for retrieval at a to-be-determined date.

Email *

STUDENT & ROOM INFORMATION

This agreement, is made on the date noted below, between Dominican University of California(hereinafter “DOMINICAN”) and the undersigned student (hereinafter "STUDENT") at Dominican University of California.

Student Name *

First Last

Assigned Building *

Edgehill Village

Fanjeaux

Pennafort

Townhomes

Assigned Room *

Please indicate your assigned room number.

ACKNOWLEDGEMENT OF TERMS

By completing this waiver and release of liability form, I acknowledge the following:
(for each section, please initial on the line below)

Student Status *

I am a student at DOMINICAN and am over eighteen years of age, or I have a parent or guardian signing on my behalf. (please type your initials below)

Unable to Return *

I am unable to return to the campus to retrieve my personal possessions prior to the end of the spring 2020 semester. (please type your initials below)

Personal Possessions Packing & Storage *

I am authorizing DOMINICAN staff/personnel to pack my personal possessions into storage boxes/containers, and I am requesting that DOMINICAN either store said possessions until I am able to retrieve it (before Sept 1, 2020), or am able to make alternative arrangements to have said possessions shipped to me. (please type your initials below)

Storage Facility *

I understand that DOMINICAN makes no warranty or representation of any kind concerning the quality or condition of the storage location on which my personal possessions will or may be stored and I hereby knowingly and voluntarily assume the risk of any damage, loss, injury, or death resulting from any defect on or in the storage facility. (please type your initials below)

Dominican Release *

I on behalf of myself, my personal representatives, heirs, executors, administrators, agents, and assigns, HEREBY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE DOMINICAN, including its governing board, trustees, directors, officers, employees, and any Participants, agents or volunteers acting at DOMINICAN’s direction (collectively referred to as "Releasees"), for any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys' fees), arising from any damage to, or loss of, personal possessions that I may suffer as a result of my authorizing DOMINICAN to pack and store/ship my personal possessions, REGARDLESS OF WHETHER THE DAMAGE, LOSS, INJURY OR DEATH IS CAUSED BY THE RELEASEES, UNLESS THE DAMAGE, LOSS, INJURY OR DEATH IS CAUSED SOLELY BY THE RELEASEES’ NEGLIGENCE OR GROSS NEGLIGENCE OR INTENTIONAL MISCONDUCT, AND REGARDLESS OF WHETHER THE DAMAGE, LOSS, INJURY OR DEATH OCCURS WHILE IN STORAGE OR IN TRANSIT. I further agree that the Releasees are not in any way responsible for any damage, loss, injury or death that I sustain as a result of my own negligent or grossly negligent acts or my own intentional misconduct and I hereby release Releasees from any liability for the same. (please type your initials below)

STUDENT AGREEMENT

I hereby acknowledge that I have read, understand and will abide by each of the terms and conditions of this Agreement. I understand that I may seek legal counsel of my own choosing to fully explain any terms of this Agreement to me before I sign it.

Student Name *

By typing your name below, you are signing this Agreement electronically and you agree your electronic signature is the legal equivalent of your manual signature on this Agreement.

Date *

YYYY

Student ID # *

Please enter your student ID

Parent/Guardian

Signature of Parent/Guardian for Participants Who Are Minors:I certify that I have custody of Participant or am the legal guardian of Participant by court order. I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND AND AGREE TO ITS TERMS I AM AWARE THAT THIS AGREEMENT INCLUDES A RELEASE AND WAIVER OF LIABILITY, AN ASSUMPTION OF RISK, AND AN AGREEMENT TO INDEMNIFY RELEASEES.

Date

YYYY

A copy of your responses will be emailed to the address you provided.

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