Release and Waiver of Liability
I, (name), M.D. will participate as a housestaff member in the activities of the Department of (department), Section of (section), at the Medical College of Georgia from (date) to (date). I will not receive monetary compensation for this training experience, nor benefits normally provided to employees of the Medical College of Georgia, to include workers compensation.
I understand that I may be exposed to certain risks of bodily injury and other dangers, including but not limited to, exposure to blood borne pathogens, biological waste, and dangerous chemicals.  I am aware of these risks and voluntarily assume these risks.
I hereby release and forever discharge the Medical College of Georgia and its governing body, the Board of Regents of the University System of Georgia, its members (officially and individually) and its officers, agents, and employees from all claims, demands, rights and causes of action of whatever kind or nature arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, death, or damage to property arising out of my activities, including but not limited to, those specific risks enumerated above.
I understand that the acceptance of the Release and Waiver of Liability by the Board of Regents of the University System of Georgia shall not constitute nor be construed as a waiver in whole or in part of sovereign or officially immunity by said Board, its members, officers, agents, and employees.
I have read this document carefully and I voluntarily choose to participate in the activities described herein. I hereby certify that I am at least 18 years of age, I am legally competent, and I am signing this document with full knowledge of its significance.
		     	
Name of Physician, M.D.		Date
		     	
		Date