Youth Waiver Form printable pdf download

YOUTH WAIVER FORM

AS/SDSU AZTEC RECREATION

ASSUMPTION OF RISK, WAIVER, AND RELEASE FROM LIABILITY

In consideration of the use of the property, facilities, services, programs, activities and events provided by THE ASSOCIATED STUDENTS, including

any travel related thereto, the undersigned agrees as follows:

1. RISK FACTORS. The undersigned understands and acknowledges that the use of equipment and facilities provided by Associated Students and

participation in the AS/SDSU Recreation Programs (Intramurals, Sport Clubs (extramurals), Physical Sports, Weight and Cardiovascular training, Aztec

Adventures, Dance, Swimming, and any other programs and services sponsored by A.S. Campus Recreation Department) and related travel involves risk

such as, but not limited to, the following which might result from the use of the equipment or facilities, from the activity itself, from the acts of others, or

from the unavailability of emergency medical care: RISK OF PROPERTY DAMAGE, BODILY INJURY, AND POSSIBLY DEATH.

2. ASSUMPTION OF THE RISK. The undersigned ASSUMES ALL RISKS WHICH ARE FORESEEABLE AND INVOLVED WITH OR ARISE

OUT OF THE USE OF THE EQUIPMENT OR FACILITIES, THE ACTIVITY ITSELF, THE ACTS OF OTHERS, OR THE UNAVAILABILITY OF

EMERGENCY CARE, including but not limited to, those RISK FACTORS described in Section 1 above.

3. ACKNOWLEDGEMENT OF POLICIES AND PROCEDURES. The undersigned acknowledges reading and knowing all of the policies and

procedures relating to the activities, facilities and/or equipment and understands that the safe and proper use of the facilities, equipment or participation in

the activity is dependent upon carefully following such policies and procedures. (See for more information.)

4. PREREQUISITE SKILLS AND TRAINING. The undersigned acknowledges that he or she has the requisite skills, qualifications, physical ability

and training necessary to properly and safely use the equipment and facilities and to participate in the activity itself. The undersigned agrees that if he or

she has any questions as to what skills, qualifications or training is necessary to properly use the equipment, facility, or participate in the activity itself, then

they shall direct such questions to the appropriate Staff Member on site.

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ITEMS 1–4: Initials

5. RELEASE. The undersigned RELEASES the State of California, the trustees of the California State Universities, San Diego State University, the

Associated Students of San Diego State University and all of their officers, employees and agents and agrees NOT TO SUE them on account of or in

conjunction with any claims, causes of action, injuries, damage, or cost of expenses arising out of the activity, including those based on death, bodily injury

or property damage whether or not caused by the negligence or other fault of the parties being released.

6. PROMOTIONAL PERMISSION. The undersigned gives permission to the Associated Students to use my name, family member’s name, written

testimonial, written evaluation and/or photographs and video in brochures, newspapers, broadcasts, telecasts, and any other form of communication.

7. WAIVER. The undersigned waives the protection afforded by any statute or law in any jurisdiction including California Code 1542 whose purpose,

substance and/or effect is to provide that a general release shall not extend to claims, material or otherwise which the person giving the release does not

know of suspect to exist at the time of executing the release. This means, in part, that the undersigned is releasing unknown future claims.

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ITEMS 5–7: Initials

8. INDEMNIFY AND DEFEND. The undersigned agrees to INDEMNIFY AND DEFEND the State of California, the trustees of the California State

Universities, San Diego State University, the Associated Students of San Diego State University and all of their officers, employees and agents (hereinafter

jointly referred to as "indemnitee") against, and hold them harmless from any and all claims, causes of action, damages, judgments, cost or expenses,

including attorney fees which in any way arise from the activity or this agreement and which include but are not limited to damages to or destruction of any

property of the indemnitee of any others, injury or death to the undersigned or anyone else or any liability arising from the act or negligent act of the

indemnitee, the undersigned or anyone else.

PAY. The undersigned agrees to pay for any and all damages to any property or indemnitee caused by the undersigned either negligently, willfully or

otherwise.

10. LEGAL FEES. In the event of any controversy, claim or dispute between the parties arising out of or relating to this agreement or the breach hereof

or the activity, the prevailing party shall be entitled to recover from the losing party reasonable expenses, attorney fees and costs.

11. REPRESENTATIVES. The undersigned enters into this agreement for him/herself, his/her heirs, assigns and legal representatives.

12. EMERGENCY TREATMENT CONSENT. The undersigned, as a participant (parent or guardian of minor) in the subject activity, hereby consents

to medical treatment in a medical emergency where the undersigned (minor) is unable to consent to such treatment.

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ITEMS 8–12: Initials

13. INSURANCE. The undersigned understands the Aztec Recreation Program does not carry participant insurance. The undersigned is encouraged to

have a physical examination and purchase health insurance prior to any and all participation.

14. ACKNOWLEDGMENT. The undersigned has read and understands this agreement and realizes it relates to surrendering and releasing valuable

legal rights and does so freely and voluntarily.

Signature __________________________________________________________________ Date

__________________________________________________

_______

(Parent or Guardian)

ITEMS 13 -14: Initials

Revi ed 07/12

STAFF Initials __________

Youth Waiver Form

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