Emergency Ride Home (ERH) Registration

First name

Last name

Stanford ID number 
(required for students & university employees)

Daytime phone (example:1234567890)

Email address

Affiliation

University employee
Hospital, LPCH, or Clinics employee
Commuting student
Other (describe)

Department

Building where you work or study

Mail code

What commute alternative do you use?

Informed consent, waiver and release of liability

As a voluntary participant in the Emergency Ride Home (ERH) program, I understand that my participation does not in any manner imply that on acceptance of a ride from the ERH I am acting in the course and scope of official Stanford business, nor does it establish an employer-employee or an agency relationship between Stanford and the service provider.

I assume full legal and medical responsibility for all costs and expenses including risk of injury or loss, including death or serious bodily harm, and/or loss of property and income which may result from my participation in this program. I agree not to sue or bring claim against Stanford, its trustees, directors, officers, agents, or employees, by reason of any accident, illness, injury, loss, or death that is caused by or alleged to be caused by my participation in this program. The terms of this release shall serve as a release and assumption of risks for my heirs, executors, administrators, and for all of my family members.

I agree to the terms described above.