Waiver Of Liability, Assumption Of Risk And Indemnity Agreement Template
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1Complete description of Class or Activity, including date(s) and transportation (if any)
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University of California, Santa Barbara
Waiver of Liability, Assumption of Risk & Indemnity Agreement
Elective/Voluntary Activities Waiver
______________________________________________________
______________________________________________________
Department
Class/Activity
Waiver: In consideration of being permitted to participate in any way in
hereinafter called “The Activity”, I, for myself, my heirs, personal representative or assigns, do hereby
release, waive, discharge, and covenant not to sue The Regents of the University of California, its
officers, employees, and agents from liability from any and all claims including the negligence of The
Regents of the University of California, its officers, employees and agents, resulting in personal
injury, accidents, or illnesses (including death) and property loss arising from, but not limited to, participa-
tion in The Activity.
Assumption of Risks: Participation in The Activity carries with it certain inherent risks that cannot be
eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to an-
other, but the risks range from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries
such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions 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 Activity. 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 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 The Activity 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 Participant
Print Name of Participant
Date
Age (if Minor)
____________________________________
____________________________________________
____________
Signature of Parent/Guardian of Participant if Minor
Print Name of Parent/Guardian of Participant if Minor
Date
Elective/Voluntary Activities Waiver - rev. 9/03
Risk Management, UC Santa Barbara
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