Waiver and Release for Minors
(Must be completed and on file prior to using the Fitness/Wellness Center)
As the parent/guardian of _______________________, I have read and understand the fitness/wellness center policy and general
room guidelines. I acknowledge a full understanding of the inherent dangers and risks associated with the use of this facility.
As the parent/guardian of _______________________, I acknowledge that participation in this facility is strictly voluntary and has
not been requested or required by the El Camino Community College District.
As the parent/guardian of _______________________, I acknowledge it is recommended that my child seek approval from his/her
physician before implementing an exercise regimen, as there may be significant health risks associated with exercising. As the
parent/guardian of _______________________, I understand that injury or death may result if equipment is not used properly.
As the parent/guardian of _______________________, I declare my child to be physically sound and suffering from no condition,
impairment, disease, infirmity, or other illness that would prevent his/her participation in any fitness/wellness facility activity. As
the parent/guardian of ____________________, I acknowledge that he/she has either had a physical examination and has been
given a physician’s permission to participate in these activities, or I have decided to allow my child to participate in these activities
without the approval of his/her physician.
As the parent/guardian of _______________________, I understand that the activities, facilities, programs, and services offered by
the El Camino College Fitness/Wellness Center may sometimes be conducted by persons who may not be knowledgeable, licensed,
certified or registered instructors or professionals. As the parent/guardian of _______________________, I accept the fact that the
skills and competencies of some Fitness/Wellness Center employees, agents, representatives, or volunteers will vary according to
their training and experience and that no claim is made to offer assessment or treatment of any mental or physical disease or
condition by those who are not duly licensed, certified or registered and employed to provide such professional services.
As the parent/guardian of ____________________, I agree at all times to protect, indemnify, and hold El Camino Community College
District, its Board of Trustees, officers, agents, employees, and volunteers free and harmless, and to provide legal defense, from any
and all liabilities, claims, losses, judgments, damage, demands or expenses resulting from my child’s use or occupancy of the
District’s Fitness/Wellness Center facilities.
As the parent/guardian of ____________________, I agree to be responsible for the loss of or damage to any of the District’s
Fitness/Wellness Center facilities including any equipment to be used therein. As the parent/guardian of
______________________, I further agree to reimburse the District for any equipment that is damaged as a result of misuse by my
child.
My child has been provided an opportunity to review instructions for the proper usage of all the equipment in the facility. My child
agrees not to use any equipment unless he/she is familiar with its proper use.
My child agrees to follow all guidelines set forth in this document and as updated in the fitness/wellness center and as he/she
acknowledges that any violation of the guidelines may result in this privilege being withdrawn.
Name of Participant (please print clearly): _____________________________ Date: ____________________
Signature of Participant: _________________________________
Name of Participant’s Parent/Guardian (please print clearly): _____________________ Date: _______________
Signature of Participant’s Parent/Guardian: _________________________________
_________________________________________________________________________________________________________
For official use only:
Prepared by: ________________________________ Date: ________________________
Student District Employee Community Education
ID ID Enrollment Verification
ASB (required) ASB Waiver/Release
Waiver/Release Waiver/Release Orientation
Orientation Orientation
