Trip Agreement Form (Page 2 of 2) in pdf

Liability Form

Acknowledgment of Risk

I_hereby_acknowledge_and_agree_that_participation_in_the_above_activity_has_inherent_risks._I_have_full_knowledge_of_the_nature_and_extent_of_

all_risks_associated_with_this_activity,_including_but_not_limited_to:

•_ Injury_in_the_form_of_cuts,_bruises,_abrasions,_muscle,_tendon_strain_and_rope_burn.

•_ Failure_to_follow_safety_policies_and_procedures_and/or_follow_directions_from_activity_leaders.

•_ The_presence,_actions_or_falls_of_other_participants.

•_ Misuse_of_equipment_or_facilities,_or_failure_of_equipment.

•_ Fatigue,_chill_and/or_dizziness,_which_may_diminish_reaction_time_and_increase_the_risk_of_accident.

•_ Slips,_trips,_falls_or_painful_crashes_while_using_the_facilities_or_equipment.

•_ Potential_for_drowning_or_other_injuries_caused_by_moving_water.

I_understand_the_description_of_these_risks_is_not_complete_and_that_other_unknown_or_unanticipated_risks_may_result_in_injury,_illness_or_

death._

Assumption of Risk and Responsibility

In recognition of the inherent risks of the above activity, I the undersigned user, agree to release and on behalf of myself, my

heirs, representatives, executors, administrators and assigns hereby do release Kent State University, its agents, officers,

employees, participants, volunteers and all other persons or entities acting in any capacity on its behalf from any cause of action,

claims or demands of any nature related to my participation in the above activity:

1._ I_acknowledge_that_the_above_activity_entails_known_and_unanticipated_risks,_which_could_result_in_physical_or_emotional_injury,_

paralysis,_death,_or_damage_to_myself,_to_property_or_to_third_parties._I_hereby_certify_that_I_have_full_knowledge_of_the_nature_of_

risks_of_the_above_activity_and_further_understand_that_such_risks_simply_cannot_be_eliminated_without_jeopardizing_the_essential_

qualities_of_the_activity.

2._ I_expressly_agree_and_promise_to_accept_and_assume_all_of_the_risks_existing_in_this_activity._My_participation_in_this_activity_is_

purely_voluntary,_and_I_elect_to_participate_in_spite_of_the_risks.

3._ I_hereby_voluntarily_release,_forever_discharge,_and_agree_to_indemnify_and_hold_harmless_Kent_State_University_for_any_and_

all_claims,_demands,_or_causes_of_action,_which_are_in_any_way_connected_with_my_participation_in_this_activity_or_my_use_of_

Kent_State_University_equipment_or_facilities,_including if such injury or damage is due to the negligence of KSU and its

employees.

4._ Should_Kent_State_University,_or_anyone_acting_on_its_behalf,_be_required_to_incur_attorney’s_fees_and_costs_to_enforce_this_

agreement,_I_agree_to_indemnify_and_hold_such_harmless_for_all_fees_and_costs.

5._ I_certify_that_I_have_adequate_insurance_to_cover_any_injury_or_damage_I_may_cause_or_suffer_while_participating,_or_else_I_agree_to_

bear_the_costs_of_such_injury_or_damage_to_myself.__I_further_certify_that_I_am_in_good_health,_and_that_I_have_no_medical_or_physical_

conditions_that_could_interfere_with_my_safety_in_this_activity,_or_else_I_am_willing_to_assume–and_bear_the_costs_of–all_risks_that_

may_be_created,_directly_or_indirectly,_by_any_such_condition.

I certify that I have fully read and understood the forgoing acknowledgment of risks and assumption of risk and responsibility.

I agree to abide by the policies and procedures of the Crooked River Adventures and follow all directions of the activity leaders.

I further understand that the terms of this agreement are legally binding.

______________________________________________________________________________________________________

Participant Name (Please Print)

Signature

Date

______________________________________________________________________________________________________

Signature of Parent or Guardian (If Under 18)

Date

Office Use Only

Trip_Number:______________________________ Date:_ __________________________________ Initials:_______________

Trip Agreement Form Page 2

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