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A liability waiver and release form for participants, including minors, to assume all risks and waive claims against the university of portland and its representatives for any potential injuries or damages incurred during their participation in university activities. The participant or parent/guardian must sign the form, acknowledging their understanding of the risks involved.
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PARTICIPANT’S FULL NAME: ________________________________________________________
DATE OF BIRTH (MO/DAY/YR) AND AGE: ____________________________________________________
ADDRESS: __________________________________________________________________________________
LOCATION OF ACTIVITY(IES): ________________________________
DATE(S) OF ACTIVITY(IES): START DATE: END DATE:
Check one: STUDENT OR NON-STUDENT
DESCRIPTION OF ACTIVITIES:
POTENTIAL RISKS INCLUDE BUT ARE NOT LIMITED TO:
I, or I on behalf of my minor child, HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS ACTIVITY, including by way of example and not limitation, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of the their possible liability without fault. I acknowledge that I am exercising my own free choice to participate voluntarily in the above-named activity, and am promising to take due care during such participation. I acknowledge that I have been informed of the nature of the activity and that I am aware of the hazards and risks which may be associated with my participation in the above-named activity, including the risks of bodily injury, death, or damage to property which may occur from known or unknown causes.
In consideration of the University of Portland (the "University") permitting me or my minor child to enroll and participate in this activity, I, or I on behalf of my minor child, hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows:
ME OR MY CHILD; and
The Release From Responsibility, Assumption of risk, and Waiver shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I have had sufficient time to review and seek explanation of the provisions contained above, have carefully read them, understand them fully, and agree to be bound by them. After careful deliberation, I voluntarily give my consent and agree to this Release From Responsibility, Assumption of Risk, and Waiver.
READ, UNDERSTOOD, AND AGREED TO THIS DAY OF , 20.
Signature of Participant whose printed name appears above:
Signature Date
If participant is under the age of 18, his or her parent or legal guardian must also sign :
I, (printed name) ________________________________________________, warrant and represent that I am the parent or legal guardian of the participant who has signed above. Acting in such capacity, I have read and I understand the provisions of this document, I consent to the participant taking part in the course described above, and I fully enter into and agree, individually and on behalf of the participant, to the terms of the above Release From Responsibility, Assumption of Risk, and Waiver. I further agree to save and hold harmless and indemnify each and all of the released persons or entities referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said persons or entities on behalf of the participant and the parents or legal guardian.
Signature of Parent or Legal Guardian Date