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RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION (California State University, Dominguez Hills)

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RELEASE OF LIABILITY, PROMISE NOT TO SUE,
ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS
COVID-19
Activity:
Activity Date(s)
and Time(s):
Activity
Location(s):
Travel Request #:
(if applicable)
In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs and
representatives, I release from all liability and promise not to sue the State of California, the Trustees of The California
State University, California State University, Dominguez Hills and their employees, officers, directors, volunteers and agents
(collectively “University”) from any and all claims, including claims of the University’s negligence, resulting in any physical
or psychological injury (including paralysis and death), illness, damages, or economic or emotional loss I may suffer because
of my participation in this Activity, including travel to, from and during the Activity. I am voluntarily participating in this Activity. I
am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to
physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis),
economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other’s
actions, inaction, or negligence; conditions related to travel; or the condition of the Activity location(s). Nonetheless, I assume
all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and
during the Activity.
I agree to hold the University harmless from any and all claims, including attorney’s fees or damage to my personal property,
that may occur as a result of my participation in this Activity, including travel to, from and during the Activity. If the University
incurs any of these types of expenses, I agree to reimburse the University. If I need medical treatment, I agree to be financially
responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health
insurance.
I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the
University from all liability, (b) promising not to sue the University, (c) and assuming all risks of participating in this
Activity, including travel to, from and during the Activity.
I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I agree
that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms.
I have been informed and understand there remains a risk of exposure to COVID-19. I understand that regardless of any
precautions taken, an inherent risk of exposure to COVID-19 will exist.
I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document
have been made to me.
Participant's Signature:
________________________________________________
Participant's Name (Print):
________________________________________________
Date: ________________________________________________
Please submit this form to Risk Management at riskmanagement@csudh.edu
If Participant is under 18 years of age:
I am the parent or legal guardian of the Participant. I understand the legal consequences of signing this document,
including (a) releasing the University from all liability on my and the Participant’s behalf, (b) promising not to sue on
my and the Participant’s behalf, (c) and assuming all risks of the Participant’s participation in this Activity, including
travel to, from and during the Activity. I allow Participant to participate in this Activity. I understand that I am responsible
for the obligations and acts of Participant as described in this document. I agree to be bound by the terms of this document.
I have read this two-page document, and I am signing it freely. No other representations concerning the legal effect of this
document have been made to me.
Minor Participant's Parent/Guardian Signature: ______________________________________________
Minor Participant's Parent/Guardian Name (Print): ______________________________________________
Minor Participant's Name (Print): ______________________________________________
Date: ______________________________________________
Please submit this form to Risk Management at riskmanagement@csudh.eduPlease submit this form to Risk Management at riskmanagement@csudh.edu
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RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION (California State University, Dominguez Hills)

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Completed 8 July 2022

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