Waiver of Liability and Hold Harmless Agreement

Please enter the event/activity approval ID number:*

This should have been given to you with the link to this form.

Title of event/activity:*

Description of event/activity:*

Explanation of risk(s) and steps to prevent or limit the risk(s) in this activity:*

Campus:

Colorado location:*

Utah location:*

Other location specified:*

Date of event/activity:*

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Contact person:*

Contact phone number:*

Will there be any minors accompanying you over which you are a parent or legal guardian?*

Yes
No

Please list all minors that will be attending over whom you are specifically a parent or legal guardian:*

FIRST NAME	LAST NAME	AGE

Acknowledgement:*

I agree to the following:

I affirm that I am at least 18 years of age and I am the parent or legal guardian of the minor child(ren) referenced in this form, and am freely signing this agreement. I have read this form and the risks associated with participation in the event and fully understand that by signing this form I am giving up legal rights and/or remedies which may otherwise be available to me regarding any losses or injuries my child(ren) may sustain as a result of their participation in this event. I agree that if any portion is held invalid, the remainder will continue in full legal force and effect.

Emergency contact number for parent/guardian:*

Liability release and acknowledgement:*

I agree to the following:

In consideration of being allowed to participate in the activity described below, I hereby release, hold harmless and forever discharge Rocky Vista University, LLC, the Rocky Vista University Board of Trustees, and each and every officer, agent, and employee of each of the above referenced entities from all claims, causes of action, or demands of every kind which I may have in the future or that any person claiming through me may have in the future against any of them by reason of any injury to person or property, or death, in connection with my participation in the activity described below.

I certify that I am in good physical health and am physically able to participate in the described activity. I understand and acknowledge that serious accidents sometimes occur during activities such as this, and that some medical conditions may be exacerbated or aggravated, and that participants occasionally sustain mortal or serious personal injuries and/or property damage as a consequence thereof, and that my participation could result in loss of or damage to my property, serious injury to my body or to others, and/or my death.

I have been advised to ensure that I have personal medical coverage. I understand that I am agreeing to use my personal insurance as a primary medical coverage if an accident or injury occurs. I have been informed of the risks and know the safety procedures to follow that are inherent in this activity.

I accept all responsibility to handle potentially dangerous situations and know that I am personally responsible for any emergency procedures necessary for this activity.

Participant's signature:*

I have read this Release, and understand the terms used in it and their legal significance. This Release is freely and voluntarily given with the understanding that rights to legal recourse against Rocky Vista University, LLC, the Rocky Vista University Board of Trustees, and each and every officer, agent, and employee of Rocky Vista University, LLC, are knowingly given up in return for allowing my participation in the activity described above.

Date*

Participant's name:*

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