Release, Waiver Of Claim And Assumption Of Risk Agreement
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2RELEASE, WAIVER OF CLAIM AND ASSUMPTION OF RISK AGREEMENT
TODAY'S DATE
I,
of
(Name of Participant)
(Address)
Would like to participate in the optional, extra-curricular program offered by
, Title
(Name of Student Organization)
(Title of Program)
at
which will start on
(Location of Event)
(Date/Time)
and end on
.
(Date/Time)
I acknowledge that I am aware that there are risks to me of injury or property damage entailed in my participation in this
extra-curricular program, including the risks of travel to and from this program. My participation in this elective program
is voluntary decision on my part. I do fully and completely assume any risks solely to myself, and accept full
responsibility for my individual physical fitness to participate in this program. Although Boston University will provide
as much information as possible on this program, I understand that it is my responsibility to request further information if
I require such information in order to make a proper participation decision. I understand that the University gives no
assurances or warranties whatsoever as to the safety of participants in this program.
In consideration of being presented an opportunity to participate in this optional, elective program and in acknowledging
that I am aware of and willing to assume the risks associated with this program, I hereby voluntarily agree to waive, hold
harmless and indemnify the Trustees of Boston University and its trustees, agents, volunteers, employees and
, including its individual
(Name of Student Organization)
members, from any and all claims, demands, damages and causes of action of any nature whatsoever arising out of
ordinary negligence which I, my heirs, my assigns or successors may have against them for, on account of, or by reason of
my voluntary involvement with this elective program offered by a Boston University student organization. I understand
the content of this document, and I execute this GENERAL RELEASE, WAIVER OF CLAIM AND ASSUMPTION OF
RISK AGREEMENT of my own free will and accord.
(Participant's Signature)
(Date)
(if participant is under 18 years of age)
(Parent/Legal Guardian Signature)
(Date)
(Address)
(Area Code/Telephone)
(please see reverse side)
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