OSHER LIFELONG LEARNING INSTITUTE AT THE UNIV. OF MICHIGAN

MODEL OF THE PARTICIPANT Assumption of RiskRELEASE AGREEMENT

This agreement made this____day of____, 200_ is between, (name/address)’Participant’and the Regents of the University of Michigan and their faculty, staff and employees of ‘UM’.

Participant wishes to attend the____________ field trip activity of the Osher Lifelong Learning Institute at the University of Michigan (OLLIUofM).

Participant understands that the activity consists ________________and my being transported in a bus or van to the field trip destination. In consideration of participating with the Travel Program of OLLIUofM participant hereby assumes all risk of injury during the activityreleases and holds harmless theRegents of the University of Michigan and itsemployees (hereinafter collectively referred to as the *University*) and the Learning in Retirement Travel Program (hereinafter referred to as the *Program*) from any and all liability occurring during your participation in the *Program*..

In particular, Participant understands that there is a risk of the undersigned acknowledges thathe/she will not hold the *University* or *Program*liable for any expenses, bodily or personal injuries and/or death which can occursustained while participating in the *Program* and fully assumes all risks arising from the activity as his/her responsibility..

Furthermore, the undersigned acknowledges that he/she is aware and understands the risks involved is such activity, and assumes all risks associated therewith as his/her responsibility.

The terms and conditions of the Agreement shall be

legally binding upon the Undersigned and his/her

respective estate, representative and assigns.

____________________ _________

Participant Signature Date

For OLLIUofM:________________________ Date:

By:

Its:Osher Travel Activity

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