I further release the University, the Internship Program, the agency or project, and their directors, volunteers, employees, or agents from all harm, injury, damage of every kind, whether foreseen or unforeseen, which may befall me while I participate in this activity. I further agree to save and hold harmless the above-mentioned parties from any claim by me or my family, estate, heirs or ensigns.

Signature                                                                            Date                                              

Printed Name                                                                                                                          

I agree that if I am providing transportation to/from or during the course of a field education activity, I:

• have in my possession a valid driver’s license,
• have minimum liability insurance as required by the state of Washington ($25,000 bodily injury per person, $50,000 per accident, $10,000 for property damage),
• will use a vehicle that meets state safety standards, and
• will not exceed passenger capacity for the vehicle.

Signature                                                                            Date                                              

Driver’s License #                                                              State