Waiver Of Liability, Assumption Of Risk, And Indemnity Agreement Form
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1Participant’s Name (Please Print):____________________________________________
Last
First
UNIVERSITY OF CALIFORNIA AT __________________________________
RECREATION DEPARTMENT REGISTERED CLUB SPORTS
PARTICIPANT
SPORTING ACTIVTIES/EVENT DESCRIPTION: ________________________________________________
SPORTING ACTIVITIES/EVENT DATE(S) Begins: _______________ Ends: _________________
Waiver of Liability, Assumption of Risk, and Indemnity Agreement
In consideration of permission to participate in the Club Sports sporting activities/sporting event noted
Waiver:
above, on an off campus, as a member of the __________________ and _______________________________________,
I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue
The Regents of the University of California, its directors, officers, employees, agents, and __________________ and
_______________________________________ and its officers and members from liability from any and all claims
including the negligence of __________________ and _______________________________________ resulting in
personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in
activities, classes, observation, and use of facilities, premises, or equipment.
Signature of Parent/Guardian of Minor
Date
Signature of User
Date
Physical activity, outdoors or indoors, by its very nature, carries with it certain inherent risks that
Assumption of Risks:
cannot be eliminated regardless of the care taken to avoid injuries. __________________ and
_______________________________________may use facilities, venues, or public outdoor spaces and make available
activities such as sporting activities and league sports, classes, runs and races, outdoor adventures, community services,
recitals and trips. Some of these involve strenuous exertions of strength using various muscle groups, some involve quick
movements involving speed and change of direction, and others involve sustained physical activity which places stress on
the cardiovascular system.
The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches,
bruises, sprains, 2) major injuries eye injury or loss of sight, joint or back injuries, heart attacks and concussions, and 3)
catastrophic injuries including paralysis and death.
I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are
inherent in the activities made possible by __________________ and _______________________________________. I
hereby assert that my participation is voluntary and that I knowingly assume all such risks.
I also agree to INDEMNIFY AND HOLD The Regents of the University of
Indemnification and Hold Harmless:
California and __________________ and _______________________________________ and its officers and members
HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including
attorney’s fees brought as a result of my involvement in activities of _____________________ and
_______________________________________ and to reimburse them for any such expenses incurred.
The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is
Severability:
intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is
held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
I have read this waiver of liability, assumption of risk, and indemnity
Acknowledgment of Understanding:
agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue.
I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and
unconditional release of all liability to the greatest extent allowed by law.
Signature of Parent/Guardian of Minor
Date
Signature of Participant
Date
Participant’s Age (if minor) _______
RSC 2011.1
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