San Jose/Evergreen Community College District
Waiver of Liability, Assumption of Risk & Indemnity Agreement
Required Activities Waiver
Department Class/Activity Dean Approval/Receipt of Signed Waiver
Waiver: In consideration of being permitted to participate in any way in
( Complete description of Class or Activity, including date(s) and transportation (if any) )
hereinafter called “The Activity,” I, for myself, my heirs, personal representative or assigns
, do hereby release,
waive, discharge, and covenant not to sue
the San Jose/Evergreen Community College District, its officers,
employees, and agents from
liability from any and all claims arising from bodily injury, accidents, or illnesses
(including death) to me, and property loss occurring as a result of my participation in The Activity.
Assumption of Risks: Participation in The 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, but the risks range
from 1) minor injuries such as scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or
back injuries, heart attacks, and concussions 3) catastrophic injuries including paralysis and death.
I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in
The Activity. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.
Indemnification and Hold Harmless: I also agree to
Community College District HARMLESS from any and all claims actions, suits, procedures,
costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my
involvement in The Activity and to reimburse them for any such expenses incurred.
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 California and that if any portion thereof
is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and effect.
Transportation: I hereby acknowledge and understand that unless specifically advised otherwise, the college is not
providing the transportation, and it is my responsibility to arrange for my transportation to and from the activity. If the
college is providing transportation but I do not use the transportation, I am responsible to make my own arrangements
and the college assumes no responsibility or liability of any kind.
Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement,
fully understand its terms, and
understand that I am giving up substantial rights, including my right
to sue.
I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a
complete and unconditional release of all liability to the greatest extent allowed by law.
Signature of Participant Print Name of Participant Date Age (if Minor)
Signature of Parent/Guardian of Participant if Minor Print Name of Parent/Guardian of Participant if Minor Date
SJECCD 08-13-12
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