Driver/Passenger Risk Statement for Non-College Vehicles and CCE Programs
Full name

Drivers: I understand that Middlebury College’s insurance policies will cover the costs of incidents in the vehicle I am driving for Middlebury College purposes only if I have a valid Middlebury College Driver’s License and I am driving a Middlebury College owned or rented vehicle. 

Drivers and passengers: I understand that my personal car insurance and/or I will be fully responsible for any claims or costs of incidents if I am driving, or a passenger in a personal vehicle, or any vehicle other than a Middlebury College owned or rented vehicle, even if it is for Middlebury College business. If I choose to drive or ride in a vehicle other than a Middlebury College owned or rented vehicle for Middlebury College business, I do so with full knowledge of the risk I take on in doing so. I (for myself and my heirs, executors, estate, next of kin, administrators and assigns) hereby release, discharge, and waive any and all rights or claims of any description for personal injury, death, loss of, or damage to property, or other consequential damages, due to any cause whatsoever that I may have, or which may hereafter accrue to me or on my behalf against Middlebury College, its employees, or agents. I further agree to indemnify and hold harmless Middlebury College, its employees, and agents, from all liability, claims, suits, and expenses that may arise out of my own negligent or intentional acts or omissions, while driving or riding in a vehicle other than a Middlebury College owned or rented vehicle while on Middlebury College business, and I assume full responsibility for my own actions.

Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Middlebury. Report Abuse