RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND
AGREEMENT TO PAY CLAIMS
Activity:
Activity Date(s) and Time(s):
Activity Location(s):
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,
Channel Islands 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 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 Signature:
Participant Name (print):
Date:
CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS
a campus of the California State University ▪ Bakersfield ▪ Channel Islands ▪ Chico ▪ Dominguez Hills ▪ Fresno ▪ Fullerton ▪ Hayward ▪ Humboldt ▪ Long Beach ▪ Los Angeles
Maritime Academy ▪ Monterey Bay ▪ Northridge ▪ Pomona ▪ Sacramento ▪ San Bernardino ▪ San Diego ▪ San Francisco ▪ San Jose ▪ San Luis Obispo ▪ San Marcos ▪ Sonoma ▪ Stanislaus
One University Drive
Camarillo CA 93012
Tel (805) 437-8400
Fax (805) 437-8424
7/2010 EO 1051
