Form T-4 - International Travel Release of Liability, Indemnification, and Assumption of Risk Agreement - Initial

Sep 16, 2026

Uploaded by Fahsai

Form T-4 collects individual traveler details, including destination(s), travel request number, departure and return dates, and number of personal travel days, along with university department contact information. It requires each traveler to initial designated sections and sign the agreement to confirm informed participation in an international activity. The agreement defines “Releasees,” outlines assumption of risks for Level 3 travel advisories, and includes release, indemnification, and covenant not to sue provisions under Texas law.

LanguageEnglish

CategoryForms

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

Form T-4 - International Travel Release of Liability, Indemnification, and Assumption of Risk Agreement

Individual traveler information

Initials and applicability rules

Releasees, assumption of risks, and indemnification

Release and intent to bind family and heirs

Free act acknowledgment and Level 3 advisory conditions

| | Form T-4
INTERNATIONAL TRAVEL RELEASE OF LIABILITY, INDEMNIFICATION, AND ASSUMPTION OF RISK AGREEMENT | | --- | --- | Individual Traveling: *Each adult employee or student traveler must complete this form and attach it to their Travel Request or Funds Commitment. Accompanying dependents and guests must sign the applicable T-4G (guests) or T-4M (parent/guardian on behalf of a minor) for travelers to attach as well. Destination(s): Travel Request \#: Date of Departure: / / Date of Return: / / \# of Personal Travel Days: University Department Contact: Phone \#: ( ) - Are there any dependents and/or guests traveling with you? Yes No If yes, how many? Each traveler submitting this agreement must initial all sections and sign below. This agreement is only applicable if the travel advisory is a Level 3 prior to or during travel. Travel to a country or area with a Level 3 advisory is considered voluntary travel. If an advisory is Level 1 or 2, this agreement does not apply, but travelers must ensure their travel details are registered with International SOS at least 5 days prior to departure. This is a Release of Liability, Indemnification, and Assumption of Risk agreement. Read it carefully and sign below. Completion of this form is required before you participate in the Activity. This document cannot be altered or modified by any verbal or written statements. | Initial | | --- | | Initial | | Initial | Initial Releasees: “Releasees” in this agreement are: The Texas State University System, Texas State University, and all regents, directors, employees, agents, officers, and volunteers of such entities. Assumption of Risks: I request and voluntarily choose to participate in the Texas State University (University) travel to the destination listed above. I am aware of the risks, perils and hazards connected with the Activity. I acknowledge that loss of property, personal or bodily injury, or death might result from the Activity and/or the acts of others. I elect to participate voluntarily and engage in the Activity knowing that the Activity may be hazardous to my property and me. I voluntarily and expressly agree and promise that I assume full responsibility for property loss or damage, and for personal injury, including death, that I may sustain as a result of being engaged in the Activity, whether based on the negligence or other wrongful conduct of the Releasees or not. INDEMNIFICATION: I AGREE TO INDEMNIFY, PROTECT, DEFEND (ON DEMAND), AND HOLD HARMLESS THE RELEASEES FROM ANY AND ALL LOSS, LIABILITY, DAMAGE, OR COSTS OF ANY NATURE WHATSOEVER, WHETHER NOW EXISTING OR HEREAFTER ARISING, INCLUDING WITHOUT LIMITATION , COURT COSTS AND ATTORNEY’S FEES, THAT THE RELEASEES MAY INCUR DUE TO MY PARTICIPATION IN THE ACTIVITY AS SUCH ACTIVITY IS DESCRIBED HEREIN, WHETHER CAUSED BY THE NEGLIGENCE OF RELEASEES OR OTHERWISE. FOR EXAMPLE, I SPECIFICALLY AGREE TO INDEMNIFY, PROTECT, DEFEND (ON DEMAND), AND HOLD HARMLESS THE RELEASEES FROM ANY LOSSES THE RELEASEES MAY INCUR AS A RESULT OF MY LOSS OF PROPERTY, MY PERSONAL OR BODILY INJURY OR DEATH, MY INJURING ANOTHER PERSON AND/OR MY DAMAGING ANOTHER PERSON’S PROPERTY WHILE PARTICIPATING IN THE ACTIVITY. THE INDEMNITY OWED BY ME AS SET FORTH HEREIN IS SPECIFICALLY INTENDED TO INCLUDE CLAIMS CAUSED, OR ALLEGED TO HAVE BEEN CAUSED, IN WHOLE OR IN PART, BY THE RELEASEES’ OWN NEGLIGENCE. Release: In consideration for facilitating my participation in the Activity described herein, I release, discharge, and agree not to sue the Releasees for any claims, demands, actions, and causes of action of any nature whatsoever, including, without limitation, any claims of negligence, arising out of any loss or damage to my property and/or any personal injury or death, that I may sustain, whether or not caused by the negligence of any of the Releasees, Initial Initial Initial while participating in the Activity, whether supervised or unsupervised, or while

FAQs

Who must complete Form T-4 and when is it required?

Each adult employee or student traveler must complete the form and attach it to the Travel Request or Funds Commitment. It applies when the travel advisory is Level 3 prior to or during travel.

What do travelers need to do before participating in the activity?

Travelers must read the agreement carefully, initial all required sections, and sign below. Completion of the form is required before participation.

What obligations are included in the release and indemnification terms?

Travelers assume full responsibility for property loss or personal injury, including death, and agree to indemnify, protect, defend, and hold harmless the Releasees from losses, liabilities, damages, or costs related to participation.

Sep 16, 2026

Uploaded by Fahsai