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Physical Education Program
Department of Physical Education,
Health, and Recreation |
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ACKNOWLEDGEMENT OF RISK AND
HOLD HARMLESS AGREEMENT |
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This form is to be used foran INDIVIDUAL THAT IS UNDER THE AGE OF 18,
THE SIGNATURE OF A PARENT OR GUARDIAN IS REQUIRED. |
Acknowledgment of Risk:
I hereby acknowledge that I have voluntarily chosen to participate
in the activities of the Physical Education Program (hereinafter
called “Program”) through Western Washington University’s Physical
Education, Health and Recreation Department. I understand the risks
involved. I recognize that the physical education classes and their
activities which include but are not limited to motor skills,
fitness, outdoor recreation, games, sports, modified, creative,
rhythmic, individual, dual and team, involve risk of injury and
I agree to accept any and all risks associated with the activities,
including but not limited to property damage or loss, minor bodily
injury, severe bodily injury, illness and death. Furthermore, I
recognize that my participation
in the Program involves activities incidental thereto, including but
not limited to, travel to/from Program
activities, limited availability of medical aid and the possible
negligent or reckless conduct of other participants. By voluntarily
participating in the Program with the knowledge of the risks
involved, I hereby agree to accept any and all inherent risks of
property damage, bodily injury, or death.
I understand that I am responsible for researching and evaluating
the risks that I may face and am responsible for my actions. Any
activities that I may take part in, whether as a component of the
Program or separate from it, will be considered to have been
undertaken with my approval and understanding of any and all risks
involved.
Indemnification and Hold Harmless:
In consideration of my participation in the Program and to the
extent permitted by law, I agree to indemnify,
defend and hold harmless Western Washington University, its
trustees, officers, directors, employees, agents, volunteers and
assigns from and against all claims arising out of or resulting from
my participation in the Program. “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 Western Washington University, its
trustees, 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
Western Washington University, its trustees, officers, directors,
employees, agents, volunteers and assigns for any claim arising out
of my participation in the activity, except for claims arising out
of the sole negligence or willful misconduct of Western Washington
University, its trustees, officers, directors, employees, agents,
volunteers and assigns.
I understand that Western Washington University does not provide any
medical, dental 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 or financial resources to cover expenses related to
these things.
I further understand that this acknowledgement of risk and hold
harmless is intended to be as broad and inclusive as permitted by
the laws of the State of Washington, or any other applicable laws,
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
Program.
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I have read and understand this acknowledgement of risk and hold
harmless agreement .
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PERMISSION TO
USE A PHOTOGRAPH, VIDEO, LIKENESS,
VOICE OR STATEMENT |
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Western
Washington University
MAY or
MAY NOT (check one box) use my
photographic or video image,
likeness, voice or statement, in
whole or in part, without limitation
or compensation, for use in
Department of Physical Education,
Health and Recreation (PEHR)
newsletters, publications or web
sites. Images may be modified or
retouched as needed.
Western Washington University
MAY or
MAY NOT (check one box) use my
name to identify the photograph or
video image, likeness, voice or
statement |
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