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 _______________________________
REGISTERED/RECOGNIZED STUDENT or CAMPUS ORGANIZATION (RSO)/(RCO)
NAME of RSO/RCO:___________________________________________________
PARTICIPANT
SPORTING EVENT DESCRIPTION:______________________________________________________
SPORTING EVENT DATE(S) Begins:_________________________ Ends:_______________________
Waiver of Liability, Assumption of Risk, and Indemnity Agreement
Waiver:
In consideration of permission to participate in the sporting event noted above, on an off campus, as a
member of the ______________________________________________, 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 its officers
and members from liability from any and all claims including the negligence of The Regents of the University of
California 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
Assumption of Risks:
Physical activity, outdoors or indoors, by its very nature, carries with it certain inherent risks that
cannot be eliminated regardless of the care taken to avoid injuries. _____________________________________________
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 such as 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________________________________________________________________.
I hereby assert that my participation is voluntary and that I knowingly assume all such risks.
Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD The Regents of the University of
California 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 to reimburse them for any such expenses incurred.
Severability:
The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is
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.
Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity 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) _______
RSO/RCO 8/11 – Participant Waiver
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