Participant Release and Waiver of Liability Agreement
Lock Haven University Student Auxiliary Services, Inc.
Parsons Union Building, Lock Haven University
In consideration of being allowed to participate in any club or organization that is sponsored or organized by Lock Haven
University Student Auxiliary Services, Inc. (“SAS”), and any events and activities sponsored by SAS, and intending to be legally
bound, the undersigned (on behalf of himself or herself, and his or her personal representatives, assigns, and heirs) agrees that:
1. Prior to participating in any Activity (as defined below), the undersigned will inspect the facilities and equipment to be
used, and if he or she believes anything is unsafe, he or she will immediately advise a coach, supervisor, advisor, or SAS
representative of such conditions.
2. He or she acknowledges and fully understands that by engaging in athletic activities, clubs, organizations, or other
participatory activities sponsored by SAS (each, an “Activity” or collectively, “Activities”), he or she, and each
participant, will engage in activities that involve risk of foreseeable and unforeseeable serious bodily injury, including
permanent disability, paralysis, and death, and may result in significant social and economic losses; such injuries and
losses may result from the participant’s own actions or inactions, or the actions, inactions, or negligence of others, the
condition of the premises on which such Activities occur, or from the use (improper or otherwise) of any equipment, or
from other conditions that may occur during the course of the Activity.
3. The undersigned assumes all of the foregoing risks and accepts personal responsibility for all losses, costs, and damages
that may occur as the result of the undersigned’s participation in SAS Activities, including losses and damages
associated with injury, permanent disability, or death.
4. The undersigned hereby generally releases, waives, discharges, and agrees not to sue SAS, its affiliated clubs and
organizations (including the directors, officers, agents, administrators, and representatives of any of the foregoing
entities), and any coaches, volunteers, sponsors, promoters, and, if applicable, owners and lessors of premises used to
conduct the Activity (all of whom are hereinafter referred to as “Releasees”), from any and all liability, demands,
claims, suits, losses, or damages incurred as the result of the undersigned participation in any Activity (or caused, or
alleged to be caused, in whole or in part, by the negligence of the Releasees).
5. If the undersigned, or anyone on the undersigned’s behalf, makes a claim against any of the Releasees, the
undersigned will indemnify, save and hold harmless, each of the Releasees from any litigation expenses, attorney fees,
loss, liability, damage, or cost which any of the Releasees may incur as the result of such claim.
The undersigned has read the above waiver and release, understands that she or he has given up substantial rights by signing it,
and signs in voluntarily.
*Please print clearly*
__________________________________________________ __________ _________________________________________
Print Name Signature
_______________________________________ ____________________________________________ _____________
Student ID Number Club Name Date
Emergency Contact Name: _________________________________________________
Relationship of Emergency Contact: _________________________________________
Emergency Contact Phone Number: _________________________________________
Date Rec’d