In consideration of being offered passage in a boat belonging to the University of Southern Mississippi, Institute of Marine Sciences, Gulf Coast Research Laboratory, I, the undersigned, do hereby waive for myself and for my estate any rights to claims for damages, incident to death or any bodily injuries whatsoever that may result from embarking, disembarking or being on board any boat belonging to The University of Southern Mississippi, the Institute of Marine Sciences or the Gulf Coast Research Laboratory.

This instrument releases the state of Mississippi, the University of Southern Mississippi, the Institute of Marine Sciences, the Gulf Coast Research Laboratory and any employee of the State or of these entities from liability for death or bodily injury to the undersigned occurring under the circumstances as described above.

I have read the above instrument and fully understand its intent.

Please fill out, print and sign this page and submit along with the Field Trip Roster(s), when checking into the Laboratory. Submit a release form for each participant.

Name

*Parent Guardian

Master of the Vessel