Palm Beach State College
  • Potluck Liability Waiver Form

  • I hereby acknowledge and assume the risk associated with my voluntary participation in student organized functions where food products may be provided by participants/ students including, but not limited to, “bring a dish parties” or “potluck parties.” I assume full responsibility for my health and wellbeing and for any bodily injury or illness associated with the consumption of any such food products. I further indemnify and hold harmless Palm Beach State College and its agents, trustees, employees, staff and faculty from any claims or causes of actions that I may have, or my estate, representatives or heirs may have which arise from my participation and consumption of food products at any such event. I acknowledge that the event is not organized by PBSC and that PBSC has no involvement in the preparation of or handling of food products.

    For more information about food safety, please visit www.FDA.gov.

  • Date of the Event*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: