Main Release Form[1]

Transcript

1 Main Form University of Nebraska Campus Recreation WAIVER AND RELEASE OF LIABILITY for Campus Recreation Activities DISCLAIMER: The UNIVERSITY OF NEBRASKA is NOT RESPONSIBLE for any injury or loss of property to any person suffered while warming up, practicing, traveling, playing, or participating in Campus Recreation Activities for any reason whatsoever, including ordinary negligence. and This was executed this ____ day of ___________ 2____, at Lincoln, WAIVER RELEASE OF LIABILITY (Releasor) in favor of the UNIVERSITY OF Lancaster County, State of Nebraska by _____________________, NEBRASKA and its Regents, Officers, Employees, Instructors, Staff, agents, operators, successors, and assigns (University). Releasor wishes to participate in Campus Recreation Activities . In consideration for the privilege of The Releasor consents and agrees to the following: participation in the program, the 1. Releasor certifies that he/she is physically capable of participating in Campus Recreation Activities and that he/she will take responsibility for physical fitness and capability to perform under normal Releasor is encouraged to get his/her physician’s conditions of Campus Recreation Activities. opinion prior to participating in any Campus Recreation Activities. In the event of a medical emergency, the University of Nebraska or its representatives have my permission to take whatever measures they deem reasonable to render assistance and that I and/or my family will be financially responsible for any expenses involved. 2. Releasor realizes that participation in Campus Recreation Activities involves certain risks and danger and is a vigorous activity involving severe respiratory and cardiovascular stress. Releasor has hereby been made aware that participation in Campus Recreation Activities has the following non-exclusive list of certain risks which I accept: death; head, eye, neck, and spinal injury resulting in complete or partial paralysis; brain damage; heart attack; blisters; cuts; lacerations; abrasions; concussions; contusions; strains; sprains; dislocations; fractures; cold and heat injuries; water immersion; drowning; lightning strikes; injury to bones, joints, muscles, internal organs; and environmental conditions. In addition, I understand and accept the incidental risks of travel to and from the site of activity; participation at sites that may be remote from available medical assistance; and the possible reckless conduct of other participants. 3. Consequently, while understanding that the University has taken precautions to provide organization, supervision, and equipment for reasonable safety, Releasor assumes joint and personal responsibility for safety while participating in Campus Recreation Activities. Pursuant to that joint and personal Releasor agrees to comply with the instructions and direction of representatives and responsibility, staff members of Campus Recreation. Releasor understands that failure to abide by the instructions and rules may result in his/her termination from the activity. Releasor accepts personal responsibility to ensure that any equipment needed to participate in the Campus Recreation Activities and used by the Releasor is safe and functioning properly and to refrain from causing loss or damage to the realizes that he/she is solely responsible property of the University and Campus Recreation. Releasor 1MainRelease2002.doc

2 for any personal equipment, supplies, or property he/she may choose to use during the duration of the activity. Releasor 4. for any and all claims or further agrees to indemnify and hold harmless the University University actions as a result of engaging in, using facilities and equipment, or receiving instruction for Campus Recreation Activities or any activities incidental thereto whatsoever, whenever, or however the same may occur. 5. acknowledges that photographs and digital images may be taken during participation. Releasor understands and agrees that the images may be published and used by the University. Releasor 6. Releasor is aware that if he/she uses a vehicle not operated by the University for transportation to, at, University is NOT responsible for any damage caused by or arising or leaving the activity site, the Releasor’s from acknowledges that he/she is solely use of such vehicle. Furthermore, Releasor University responsible for any action he/she takes outside the scope of those actions permitted by the for purposes of the particular activity regardless if occurring before, during, or after the duration of Releasor agrees to follow University policies when operating a University owned the activity. vehicle. In consideration of participation in Campus Recreation Activities, Releasor hereby RELEASES and 7. UNIVERSITY for any and all present and future claims resulting from covenants not-to-sue the UNIVERSITY for property damage, personal injury, or ordinary negligence on the part of the wrongful death arising as a result of my engaging in, using University facilities and equipment, or receiving instruction for Campus Recreation Activities or activities thereto, wherever, whenever, or however the same may occur. any and all claims or actions Releasor hereby voluntarily waives resulting from ordinary negligence, both present and future, that may be made by Releasor’s family, estate, personal representative, heirs, or assigns. I have read and understand that this WAIVER is intended to be as broad and inclusive as permitted by the laws of the State of Nebraska and agree that if any part is held invalid, the remaining parts of this WAIVER AND RELEASE will continue in full force and effect as intended. I further agree the venue for any legal proceeding shall be in the State of Nebraska. I understand the rights that I am waiving and that I am freely signing this WAIVER AND RELEASE . I have read and fully understand that by signing this agreement I am giving up legal rights and remedies, which may be available to me for ordinary negligence of the University . I further agree to follow and abide by the regulations and rules of the as they pertain to Campus Recreation Activities and to reimburse UNIVERSITY and make good to the UNIVERSITY any loss, damage, or cost the UNIVERSITY may have to pay as a result of my participation in the program. _______ ________ ________ _______ _________________ _______________ RELEASOR (Signed) University ID # Date RELEASOR (Printed) The following is for informational purposes only: _______________________ _______________________ ____________________________________ Emergency Contact Contact Phone # Contact Address, City & State No Releasor’s Gender: M F Releasor’s Age: 19 years of age or older (circle) Yes 1MainRelease2002.doc

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