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Columbia Basin College - Waiver & Release of Liability
Read each statement below before completing and signing this Waiver & Release. Parent/Guardian
consent is required for participants under the age of eighteen (18).
This Agreement is entered into pursuant to and under the authority granted by the laws of the
State of Washington and any applicable federal laws. In consideration for my participation in this Columbia
Basin College (CBC) sponsored activity I acknowledge, understand and agree to the following:
CBC Policies and Procedures
: I will comply with CBC's Safety, Security and Conduct Policies and Procedures,
and provisions of Washington State Administrative Code 132S, including but not limited to regulations on
Parking and Traffic, Health and Safety, Distribution of Materials, and any and all applicable policies and
procedures relating to the use of CBC facilities. (Copies of the Fitness Center Policies are available upon
Readiness to Participate
: I voluntarily and of my own free will elect to participate in activities, programs and
use of the facilities and equipment of the CBC Fitness Center and Gymnasium. I will only participate in those
activities and programs for which I believe I am physically and psychologically prepared to participate.
Medical Treatment and Consent
: I acknowledge that it is recommended that I obtain a physician’s approval
prior to my participation in any physical activity or use of exercise or other equipment. In the event that CBC
must obtain on my behalf or provide emergency medical care and/or first aid from a medical facility,
emergency medical staff and/or CBC personnel for my immediate welfare, I give my consent for the same and
shall hold harmless CBC, its employees, volunteers, trustees, directors, officers, agents, or assigns for any
injuries or losses to my person or property arising out of such care.
Insurance Statement
: I understand that it is my responsibility to obtain appropriate medical insurance
coverage, and/or provide payments for all costs that may arise as a result of injury or damage related to my
participation in this activity.
Assumption of Risk
: I am fully aware of and appreciate the risks associated with participation in this activity,
including the risk of catastrophic injury, paralysis and even death, as well as other types of injuries, loss or
damages to my person or property. I knowingly and freely assume all such risks, both known and unknown,
even if arising from the negligence of CBC, its employees, volunteers, trustees, directors, officers, agents, or
Indemnification and Release of Liability
: I, for myself and on behalf of my heirs, next-of-kin, spouse, agents,
assigns, and personal representatives, agree to indemnify, defend, release and hold harmless CBC, its
employees, volunteers, trustees, directors, officers, agents, or assigns against all claims, causes of action, or
liability for any injury, loss of property, loss of life, or any other loss, expenses, costs, including attorney’s fees,
or damage arising out of my participation in [ACTIVITY NAME], use of CBC’s equipment or facilities, or care
rendered by CBC for my welfare, even if arising out of negligence.
Jurisdiction and Venue
: This Agreement is entered into pursuant to and under the authority granted by the
laws of the State of Washington. The venue for any disputes arising under this Agreement shall be Franklin
County, Washington.
I agree that this Release and Waiver Agreement is governed by the laws of the State of
Washington and is intended to be as broad and inclusive as is permitted by Washington State law, and that in
the event any portion of this agreement is determined to be invalid or unenforceable for any reason, such
invalidity or enforceability shall not affect the remaining provisions of this Agreement, which shall remain in
full legal force and effect.
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Emergency Information:
The following information is needed on file in the chance there is an emergency
within the Fitness Center. Your emergency contact will be notified and your personal information will be given
to EMS in the event that they are called.
Personal Information
Legal Name:
Current Address:
City: State: Zip:
Phone Number: DOB:
Emergency Contact Information
Relationship: Phone:
My signature below is my acknowledgement that I have read, understood and agree to the provisions of this
Waiver & Release of Liability, and I sign it freely and voluntarily without inducement.
Participant’s Signature: Date Signed:
Printed Participant's Name: Student ID #:
I, as parent/guardian with legal responsibility for this participant acknowledge that I have read, understood
and consent to this Waiver & Release of Liability and have explained the risks of the activity to the participant.
Parent/Guardian Signature: Date Signed:
Printed Parent/Guardian’s Name: Phone:
Columbia Basin College complies with the spirit and letter of state and federal laws, regulations and executive orders pertaining to civil rights, Title IX, equal opportunity and affirmative action. CBC does not discriminate on the basis of race, color, creed,
religion, national or ethnic origin, parental status or families with children, marital status, sex (gender), sexual orientation, gender identity or expression, age, genetic information, honorably discharged veteran or military status, or the presence of any sensory,
mental, or physical disability, or the use of a trained dog guide or service animal (allowed by law) by a person with a disability, or any other prohibited basis in its educational programs or employment. Questions or complaints may be referred to the Vice
President for Human Resources & Legal Affairs and CBC’s Title IX/EEO Coordinator at (509) 542-5548. Individuals with disabilities are encouraged to participate in all college sponsored events and programs. If you have a disability, and require an
accommodation, please contact the CBC Resource Center at (509) 542-4412 or the Washington Relay Service at 711 or 1-800-833-6384. This notice is available in alternative media by request.
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