NWACC Office of Human Resources August 2012 Page
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NORTHWEST ARKANSAS COMMUNITY COLLEGE
NWACC FITNESS CENTER AND LIFETIME FITNESS CLASS PERMISSION, RELEASE OF
LIABILITY AND MEDICAL RELEASE FORM
I hereby expressly consent to my use of the fitness center and/or participate in a lifetime fitness
class. I acknowledge that such participation will necessarily involve participation in exercises that
are physically demanding and will subject the participant to stress, anxiety and possible hazards.
I understand that the activity involves inherent other risks of INJURY. I voluntarily agree to
expressly assume all such risks which may result from the activity or in any way related to my
participation in the activity.
In consideration of the right to participate in the activity, I hereby release from any legal liability
Northwest Arkansas Community College (“NWACC”), and its trustees, employees, faculty, staff,
agents, instructors and all individuals assisting with the activity for injury or death caused by or
resulting from my participation in the activity or in any way connected with my participation in the
activity, whether such injury or death was caused by the alleged negligence of NWACC, another
participant, or any other person or cause. This agreement will apply for each and every day I
engage in the activity during the CURRENT SCHOOL YEAR without requiring me to sign an
additional form for each day or activity.
I further agree to defend and indemnify NWACC for loss or damage, including any that result from
claims or lawsuits for personal injury, death, or personal property damage, relating to the activity or
use of NWACC facilities or equipment.
I represent that I am in satisfactory physical condition to participate in the activity. I authorize any
person connected with the activity or NWACC to administer first aid to me, as they deem
necessary. I authorize medical and surgical care and transportation to a medical facility or hospital
for treatment necessary for my well being, at my expense.
This agreement is governed by the laws of the State of Arkansas, and exclusive jurisdiction shall be
in the circuit court of Benton County, Arkansas or in the United States District Court, Fayetteville,
Arkansas division. If any part of the agreement is determined to be unenforceable, all other parts
shall be given full force and effect. The undersigned parent or guardian acknowledges that she/he
is signing this agreement on behalf of a minor and that the minor shall be bound by the terms of the
agreement. This agreement shall be binding on the participant’s assignees, subrogors, heirs, next
of kin, executors and personal representatives.
I HAVE READ AND UNDERSTOOD THIS RELEASE OF LIABILITY AGREEMENT.
I VOLUNTARILY AGREE TO ITS TERMS.
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Signature of Participant Date of Birth Date
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Signature of Parent/Legal Guardian Date
(If Participant is under 18)
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In the Event of an Emergency, Please Contact Phone Number
