General Participant Waiver Form Laccd
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1ASSUMPTION OF RISK, WAIVER OF LIABILITY, AND HOLD HARMLESS
AGREEMENT FOR EVENT/ACTIVITY PARTICIPATION WITHIN THE LOS
ANGELES COMMUNITY COLLEGE DISTRICT
Participant’s Name:
__________________________________________________________________
Event/Activity:
College: __________________
Date: ________________
In order to participate in the event or activities sponsored by or occurring within the LOS ANGELES
COMMUNITY COLLEGE DISTRICT (the “DISTRICT”), for which _______
_______
_____
, is one of the colleges within the District, the undersigned agrees as follows:
1.
ASSUMPTION OF RISK
The undersigned seeks to participate in events or activities, such as
(“EVENT/ACTIVITY”), and understands that there may be inherent risks
associated with such an activity). The undersigned fully understands that there is the risk of
possible INJURY while participating in the ACTIVITY. The undersigned hereby asserts his/her
participation is voluntary and he/she knowingly assumes any and all risks of participation.
2.
WAIVER OF LIABILITY
The undersigned hereby for him/herself, his/her heirs, executors, administrators and assigns,
voluntarily releases, discharges, waives and relinquishes any and all claims or causes of action
for personal injury or property damage occurring to him/herself as a result of (a) his/her
participation in the ACTIVITY, (b) his/her use, misuse, or non-use of any equipment in
conjunction with the ACTIVITY, and/or (c) the negligence of the DISTRICT, the DISTRICT’s
Board of Trustees, the DISTRICT’s officers, employees, students, agents, and representatives
with respect to the my participation in the ACTIVITY.
3.
HOLD HARMLESS
The undersigned for him/herself, his/her heirs, executors, administrators, and assigns agrees that
in the event any claim or cause of action for personal injury or property damage occurring to
him/herself shall be prosecuted against the DISTRICT, the DISTRICT’s Board of Trustees, the
DISTRICT’s officers, employees, students, agents or representatives, he/she shall hold harmless
DISTRICT, the DISTRICT’s Board of Trustees, the DISTRICT’s officers, employees, students,
agents and representatives
ACKNOWLEDGMENT
The undersigned has read this agreement, fully understands its terms, and understands that he/she is
giving up substantial rights, including the right to sue for injury result of (a) his/her participation in the
ACTIVITY, (b) his/her use, misuse, or non-use of any equipment in conjunction with the ACTIVITY,
and/or (c) for the negligence of the DISTRICT and DISTRICT employees, students, agents or
representatives with respect to the supervision or instruction of the ACTIVITY. The undersigned
acknowledges that he/she is signing this agreement freely and voluntarily.
___________________________________
__________________________
Signature of Participant
Date
_______________________________________
Signature of Parent/Guardian, if participant
Date
Is less than 18 years of age
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