Assumption Of Risk / Release Of Liability Form printable pdf download

UNIVERSITY OF NEVADA LAS VEGAS (UNLV)

NEVADA SYSTEM OF HIGHER EDUCATION (NSHE)

STATE OF NEVADA

ASSUMPTION OF RISK / RELEASE OF LIABILITY FORM

NAME OF PARTICIPANT: __________________________________________AGE:________

ADDRESS:___________________________________________________________________

PHONE:_______________________________E-MAIL:________________________________

EMERGENCY CONTACT:

NAME OF PARENT OR GUARDIAN:______________________________________________

ADDRESS:___________________________________________________________________

PHONE:_______________________________E-MAIL:________________________________

In consideration of my minor child/ward being allowed to participate in this sport camp program, its related events

and activities, I, the undersigned, acknowledge, appreciate, and agree that:

1. The risk of serious injury from the sports activities involved in this program is always present due to the nature

of the sport(s); and

2. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both

known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and

assume full responsibility for my child’s participation; and

3. I willingly agree to comply with the program’s customary terms and conditions for my child’s participation. If,

however, I observe any unusual significant concern in my child’s readiness for participation and/or in the program

itself, I will remove my child from participation and bring such to the attention of the nearest official immediately;

and

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE,

DISCHARGE, COVENANT NOT TO SUE AND AGREE TO HOLD HARMLESS the Board of Regents of the

Nevada System of Higher Education, the State of Nevada and their officers, officials, agents and/or employees,

other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of premises

used for activity (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, including

costs of defense and attorney’s fees, regarding my child and/or arising from his/her activities, WHETHER ARISING

FROM RISKS ASSOCIATED WITH THIS ACTIVITY and/or the NEGLIGENCE OF THE SPONSORING

GROUP OR ANY AGENT THEROF.

5. In addition, I understand and agree that the Sponsors cannot control all of the risks associated with the indicated

activities, and may need to respond to accidents and other emergency situations. Therefore, I hereby give my

consent to the administration of any medical treatment that may be deemed by the Sponsors to be required relative to

participation, with the understanding that the costs of such treatment will be my responsibility, unless otherwise

provided below. I acknowledge that the Sponsors do not carry medical or any other insurance for participants in the

activities named, unless the participants are informed otherwise in writing. Therefore, participants must provide their

own medical, disability or other appropriate insurance. I have read the foregoing agreement and have knowingly and

willingly signed it with a full understanding of its purpose. I acknowledge that the activity specified involves

strenuous activity, and that I know of no medical reason why my son/daughter should not participate. I affirmatively

represent that I am competent to execute this agreement, intend to be bound by it, and agree that it shall be governed

by the laws of the State of Nevada.

PRINT NAME:__________________________________________________________

(Parent)

SIGNATURE: ______________________________________________DATE:_______

(Parent)

Assumption Of Risk / Release Of Liability Form

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