Updated 04-11-2013
St. Clair County Community College Activity Waiver Form
Assumption of Risk, Waiver, and Release from Liability
In consideration for being allowed to participate in: through St. Clair County Community College
(“College”), I agree as follows:
WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT ASSUMPTION OF RISK: Participation in this class/activity carries with it
certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, including:
minor injuries such as scratches, bruises, and sprains; major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions;
and catastrophic injuries including paralysis and death.
I have read the previous paragraph and I know, understand, and appreciate these and other risks that are inherent in the class/activities in which I wish to
participate. I hereby assert that my participation is voluntary and that I knowingly assume such risks.
WAIVER: I for myself, my heirs, personal representatives or assigns, do hereby covenant not to sue, and release, waive, and discharge from liability the
College, its elected and appointed officials, employees, agents, students and volunteers from any and all claims including the negligence of the class/activity
resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in activities, classes,
observations and use of facilities, premises, or equipment.
INDEMNIFICATION AND HOLD HARMLESS: I agree to indemnify and hold harmless the College, its elected and appointed officials, employees, agents,
students and volunteers from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorneys' fees, arising or
resulting from my involvement in the class/activity and to reimburse them for any such expense incurred.
CONSENT FOR EMERGENCY TREATMENT: I consent to medical treatment for emergencies that occur during or are related to the class/activity and its
facilities when I am unable to consent to such treatment
INSURANCE: I understand that I am solely responsible for any medical, health or personal injury costs relating to the class/activity, its facilities and
equipment. I understand that I am strongly encouraged to have a medical physical examination and purchase health insurance prior to any and all
participation in the class/activity, its facilities and equipment.
SEVERABILITY: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and
inclusive as is permitted by the law of the State of Michigan and that if any portion hereof is held invalid, I agree that the balance shall, notwithstanding,
continue in full legal force and effect.
POLICIES: I have received a copy of and agree to abide by all class/activity policies. Failure to do so may result in a suspension of my privilege to
participate in the class/activity, its facilities and equipment.
JURISDICTION. This Assumption of Risk, Waiver, and Release from Liability shall be governed in all respects by the laws of the State of Michigan. The
parties agree to use the State of Michigan for Jurisdiction and the County of St. Clair as Venue for any disputes between the parties related to this
Assumption of Risk, Waiver, and Release from Liability.
SEVERABILITY. If any term or provision of this Assumption of Risk, Waiver, and Release from Liability is held to be illegal, invalid or unenforceable, or the
application thereof to any person or circumstance shall to any extent be illegal, invalid or unenforceable under present or future laws effective during the term
hereof or of any provisions hereof which survive termination, then and in any such event, it is the express intention of the parties that the remainder of this
Assumption of Risk, Waiver, and Release from Liability, or the
application of such term, clause or provision other than to those as to which it is held illegal,
invalid or unenforceable, shall not be affected thereby, and each term, clause or provision of this Assumption of Risk, Waiver, and Release from Liability and
the application thereof shall be legal, valid and enforceable to the fullest extent permitted by law.
ACKNOWLEDGEMENT OF UNDERSTANDING: I have read this Waiver of Liability, Assumption of Risk, and Indemnity Agreement and fully
understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing this
agreement freely and voluntarily, and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed
by law.
Participant(s) must sign in the presence of one (1) witness. If under the age of eighteen (18), participant(s) and guardian(s) must sign this agreement. IN
WITNESS WHEREOF, participant(s) and guardian(s) (if applicable) have caused this release to be signed
this day of , 20 .
___________________________________
PARTICIPANT SIGNATURE WITNESS SIGNATURE
Participant’s Printed Name_____________________________ Witness’s Printed Name ___________________________
Consent and Release on Behalf of Minor by Parent/Legal Guardian
I am the parent or legal guardian of the above named minor. I have read and understand this Assumption of Risk, Waiver, and Release from Liability in its
entirety and understand that it relates to surrendering valuable legal rights of the minor and myself. In consideration of permitting my minor child to participate in
any activities and/or programs offered by College, I, for myself and my minor child, hereby ACKNOWLEDGE, ACCEPT AND ASSUME ALL RISKS AND
HAZARDS and WAIVE, RELEASE, COVENANT NOT TO SUE, AND HOLD HARMLESS St. Clair County Community College, its elected and appointed
officials, employees, students, agents and volunteers., with respect to any and all claims, injuries, liabilities or damages (including for negligence) arising out of
or related to my minor child’s participation in this program or its related activities. I AGREE AND UNDERSTAND THAT THIS WAIVER OF LIABILITY AND
ASSUMPTION OF RISK AGREEMENT WILL EXTEND TO ALL CLAIMED WRONGFUL ACTS OF THE RELEASED PARTIES TO THE GREATEST
EXTENT ALLOWED UNDER THE LAWS OF THE STATE OF MICHIGAN, INCLUDING THE NEGLIGENCE OF ANY OF THE RELEASED PARTIES.
I agree to be bound by all the terms of this Assumption of Risk, Waiver, and Release from Liability. I also give my consent to the participation in the activity of
the minor.
PRINTED NAME:
SIGNATURE:
_ Date:
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