VOLUNTARY ACTIVITY WAIVER, RELEASE & INDEMNITY AGREEMENT
For and in consideration of permitting _________________________________
to enroll in and participate in
(Participant)
and class instruction of _______________________________ _________________
given by Mt. San Jacinto, in
(Activity) (Activity)
City of ______________________, County of ______________________, State of California, beginning on the
______ day of __________, 2012, the undersigned hereby voluntarily releases, discharges, waives and
relinquishes any and all actions or causes of action for personal injury, property damage or wrongful death
occurring to him/herself arising as a result of engaging or receiving instructions in said activity or any activities
incidental thereto wherever or however the same may occur and continue, and the undersigned does for
him/herself, his/her heirs, executors, administrators and assigns hereby release, waive, discharge and relinquish
any action or causes of action, aforesaid, which may hereafter arise for him/herself and for his/her estate, and
agrees that under no circumstances will he/she or his/her heirs, executors, administrators and assigns prosecute,
present any claim for personal injury, property damage or wrongful death against Mt. San Jacinto Community
College District or any of its officers, agents or employees for any of said causes of action, whether the same shall
arise by the negligence of any of said persons, or otherwise.
by this instrument, to exempt and relieve Mt. San
It is the intention of ________________________________
(Participant)
Jacinto Community College District from liability for personal injury, property damage or wrongful death caused
by negligence.
The undersigned, for him/herself, his/her heirs, executors, administrators or assigns, agrees that in the event any
claim for personal injury, property damage or wrongful death shall be prosecuted against Mt. San Jacinto
Community College District, he/she shall indemnify and save harmless the same Mt. San Jacinto Community
College District from any and claims or causes of action by whomever or wherever made or presented for personal
injuries, property damage or wrongful death.
The undersigned acknowledges that he/she has read the foregoing Waiver of Liability Notice and the foregoing
three (3) paragraphs, has been fully and completely advised of the potential dangers incidental to engaging in the
activity and instructing of _____________________________________________________
, and is fully aware
(Activity)
of the legal consequences of signing the within instrument.
________________________________________ _____________________
Signature (Participant) Date
___________________________________________ _____________________
Signature (Witness) Date
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