Waiver Of Liability, Assumption Of Risk, Indemnity And Participation Agreement printable pdf download

WAIVER OF LIABILITY, ASSUMPTION OF RISK, INDEMNITY AND PARTICIPATION AGREEMENT

SAMPLE

In order to participate in any UCLA Summer Institute programs, Participants must complete and agree to this

Waiver of Liability, Assumption of Risk, and Indemnity Agreement by checking all the boxes below. For

Participants who are younger than eighteen (18) years of age, a Parent or Legal Guardian must complete this

form on behalf of the Participant named below.

Participant Name:

Date of Birth:

Date:

Name of the Parent or the Legal Guardian completing this form:

I, the Participant’s Parent/Guardian, represent and warrant that the said Participant is under my

guardianship, conservatorship, or other legal authority and that I am legally competent to understand

and complete this form.

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

Name,*during the period ____ through _____, and for any extended period agreed upon by the

Participant and the UCLA Office of Summer Sessions, 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.

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 2) major

injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 2)

catastrophic injuries including paralysis and death. 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: I further expressly agree 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 entering into the agreement freely and voluntarily,

and intend by checking this box below for this agreement to be a complete and unconditional release

of all liability to the greatest extent allowed by law.

I, the Participant’s Parent or Legal Guardian, have read, understood and agreed.

Waiver Of Liability, Assumption Of Risk, Indemnity And Participation Agreement