Waiver of Rights, Assumption of Risks, and Release of Liability, Agreement
Lead Person: Konrad Schlarbaum
Activity: Trash Art Competition
Start/End Date: February 8 - 26, 2021
Location: Facebook and Instagram
Name of Participant (print name): ____________________________
Although Pikes Peak Community College has done everything possible to ensure that our
participants have a safe and enjoyable learning experience, we wish to inform you that there
could be inherent risks, hazards and dangers that cannot be eliminated. I acknowledge that these
include, without limitation, risks from the activity itself, risks connected with my physical
condition and required exertion, risks from improper usage of equipment, and actions of other
participants or spectators. I acknowledge that I may be photographed, videotaped, and/or
recorded while engaged in this college related activity. I hereby consent to and authorize any use
and reproduction by you, or anyone authorized by you, of any and all photographs/digital
images/video tapes/recordings.
I recognize that this is a college sponsored activity and I agree to abide by all college policies, as
well as State and Federal laws during the activity. This includes omitting the use of alcohol and
illicit drugs, and not bringing or using any weapons. I am aware that if I choose NOT to abide by
college rules and policies, I will be subject to PPCC disciplinary action as well as possible State
or Federal charges. I further understand that I may be banned from future PPCC activities.
For myself, my heirs, successors, executors, I hereby knowingly and intentionally waive and
release, indemnify and hold harmless the college, Pikes Peak Community College (PPCC), The
State Board for Community College and Occupational Education, The State of Colorado,
trustees, officers, employees, agents and volunteers from and against all claims, actions, causes
of action, liabilities, suits, expenses and NEGLIGENCE of any kind of nature arising directly or
indirectly out of any damage, loss, injury, paralysis or death in connection with my participation
in this course, program or activity and/or use of this equipment and to waive all claims for
damages or losses against the state, the Board or the college which may arise from such activities.
Furthermore, I understand that this release shall be forever binding and no rescission,
modification or release there from may be made without the express written consent of Pikes
Peak Community College and State Board for Community Colleges and Occupational Education.
I, ____________________________ (print name) HAVE CAREFULLY READ, CLEARLY
UNDERSTAND, AND VOLUNTARILY SIGN THIS WAIVER, ASSUMPTION OF RISKS
AND RELEASE AGREEMENT.
_____________________________________________
Signature (Parent or Guardian if under 18)
_______________________________
Emergency Contact Name
_____________________________
Date
_____________________________
Emergency Phone
