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Liability Waiver
I expressly understand and agree to indemnify and save Southeastern Louisiana University, the
University Health Center, the Pennington Student Activity Center and the state of Louisiana
harmless from and against any and all claims, liabilities, costs, expenses, fires, injuries and/or
deaths, which arise from or are caused by, in whole or in part, directly or indirectly, the use of
College facilities or the activity hereby applied for the applicant, its employees, servants, agents,
invitees, or independent contractees. I further understand that use of College facilities, as a
voluntary request, is made at the sole risk of the applicant, and that neither the University Health
Center, the Department of Recreational Sports & Wellness, the Pennington Student Activity
Center, Southeastern Louisiana University nor the state of Louisiana make any representation,
expressed or implied, as to the suitability or fitness of such facilities.
I acknowledge that I am in good physical condition and that I will not engage in any activities
that may aggravate any present or future physical impairment that I have. I further agree to
follow all policies set forth in this document. The University Health Center and the Department
of Recreational Sports and Wellness strongly recommends that participants take a physical
examination before signing.
**If you have any physical restrictions, your physician MUST approve your activity. This form
must be accompanied by a letter from your physician approving your activity to include his/her
name, address and signature.
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Signature of Applicant Street Address
________________________________ ______________________________
Date City, State, and Zip Code
