Fill and Sign the Agreement Student Form

Acknowledgment of Risk and Hold Harmless Agreement of Student who Wants to Use College Recreation Center PLEASE READ CAREFULLY! I hereby acknowledge that I have voluntarily chosen to use the facilities and participate in the activities of _________________________________________________ (Name of College) Student Recreation Center (the Recreation Center) . The activities of the Recreation Center include, but are not limited to, Aerobic Classes, Fitness Classes, Martial Arts Classes, Intramural Sports, Climbing Wall, Open Recreation, Personal Training, Weight Training, Cardiovascular Training, Aquatic Activities and other special events (hereinafter called activity or activities) . I understand the risks involved in the activities. I recognize that each activity involves risk of injury and I agree to accept any and all risks associated with it, including but not limited to property damage or loss, minor bodily injury, serious bodily injury or death. I further recognize that my participation in the activities may lead to minor or serious bodily injury to the head, neck and back; and injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the musculoskeletal system; injury to internal organs; and injury or impairment to other aspects of the body, general health, and well-being. I understand the danger and risk of participating in the activities may not only result in bodily injury, but also in impairment of future abilities to earn a living; to engage in other business, social, and recreational activities; and generally to enjoy life. I also understand that participation in the activities involve risks incidental thereto, including but not limited to, travel to and from competitions, practices, classes; limited availability of immediate medical assistance; and the possible negligent or reckless conduct of other participants. I am voluntarily participating in the activities with the knowledge of the risks involved and hereby agree to accept any and all inherent risks of property damage, bodily injury, or death. In consideration of my participation in the activities, and to the fullest extent permitted by law, I agree to indemnify, defend and hold harmless ___________________________________ ( Name of College) , its officers, directors, employees, agents, volunteers and assigns from and against all claims arising out of or resulting from my participation in the activities. Claim as used in this agreement means any financial loss, claim, suit, action, damage, or expense, including but not limited to attorney's fees, attributable to bodily injury, sickness, disease or death, or injury to or destruction of tangible property including loss of use resulting therefrom. In addition, I hereby voluntarily hold harmless __________________________________________ ( Name of College) , its officers, directors, employees, agents, volunteers and assigns from any and all claims, both present and future, that may be made by me, my family, estate, heirs or assigns. I hereby expressly agree to indemnify, defend, and hold harmless ___________________ _____________________________________ ( Name of College) , its officers, directors, employees, agents, volunteers and assigns for any claim arising out of or incident to my participation in the program, unless claim is caused by the direct and sole negligence or willful misconduct of _______________________________________________ (Name of College) . I understand that __________________________________________ (Name of College) and ___________________________________________ ( Name of Student Recreation Center) strongly recommends that I consult with a physician prior to engaging in strenuous physical activity . I acknowledge that I am good physical condition to engage in strenuous physical activity , including, but not limited to the activities offered through the Recreation Center. If my physical condition changes at any time, I will voluntarily withdraw from the activities. I also understand that ______________________________________ (Name of College) and ___________________________________________ ( Name of Student Recreation Center) do not provide any medical or dental insurance or life insurance to cover bodily injury, illness or death, nor insurance for personal property damage or loss, nor insurance for liability arising out of my negligent acts or omissions; and I acknowledge that I am completely responsible for my own insurance to cover these expenses. I further understand that this acknowledgment of risk and hold harmless is intended to be as broad and inclusive as permitted by the laws of the State of __________________________ (name of state) and that if any portion hereof is held invalid, I agree that the balance shall, notwithstanding, continue in full legal force and effect. I agree that this acknowledgment of risk and hold harmless is effective for as long as I participate in the activities. IF THE PARTICIPANT IS UNDER THE AGE OF 18, AN ACKNOWLEDGMENT OF RISK AND HOLD HARMLESS AGREEMENT MUST BE SIGNED BY A PARENT OR GUARDIAN AND DELIVERED OR FAXED TO THE DEPARTMENT OF CAMPUS RECREATION: FAX #_______-_______-__________. FORMS CAN BE PICKED UP AT THE CAMPUS RECREATION CENTER. I have read and understand the Office of Campus Recreation's acknowledgement of risk and hold harmless agreement Witness my signature this ________________________________ (date) . ______________________________________ STUDENT