Youth Camp Registration Form (Page 4 of 4) in pdf

Participant’s Name:______________________________

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UNIVERSITY OF CALIFORNIA, IRVINE

Campus Recreation and Anteater Recreation Center Youth Camp

Waiver of Liability, Assumption of Risk, and Indemnity Agreement

Waiver: In consideration of being permitted to participate in any way in

Campus Recreation or Anteater Recreation Center Youth Camp Programs. Including but not

limited to participating in Archery, Badminton, Cooking, Fencing, High Ropes, Rock Climbing,

and Other Youth Programs or other Drop-in Activities, hereinafter called “The Activity”, 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 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, participation in The Activity.

_________________________________

__________________________________

Signature of Parent/Guardian of Minor Date

Signature of Participant

Date

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

another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains to 2) major

injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 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 Parent/Guardian of Minor Date

Signature of Participant

Date

Participants Age (if minor) ________

Volwaiver 1/14

Youth Camp Registration Form Page 4

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