Physical Education Program Department of Health and Human Development
ACKNOWLEDGEMENT OF RISK AND HOLD HARMLESS AGREEMENT
 
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 Department of Health and Human Development. I understand the risks involved. I recognize that the physical education classes and their activities including but 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.
 
I have read and understand this acknowledgement of risk and hold harmless agreement.
 
 
PERMISSION TO USE A PHOTOGRAPH, VIDEO, LIKENESS, VOICE OR STATEMENT
 
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 Health and Human Development (HHD) newsletters, publications or websites. 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. .
 
Name (please print):
 
Signature Date:
 
IF THE PARTICIPANT IS UNDER THE AGE OF 18, THE SIGNATURE OF A PARENT OR GUARDIAN IS REQUIRED BELOW.
 
Name (please print):
 
Signature Date: