Please fill and print. Each participant must complete and agreement to participate.
In consideration of being allowed to participate in ___________________, related events and activities, I the undersigned, acknowledge, appreciate, and agree that:
The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death.
Kayaking or canoeing involves substantial risks of injury and other dangers associated with participation in such recreational activities. Dangers include but are not limited to: broken bones, sprains, bruises, concussion, and heart attack. Each participant in the above listed activities should realize that there are inherent risk, hazards and dangers involved including the training, instruction and participation in such activities. It is the responsibility of each participant to engage only in activities for which he/ she have the prerequisite skills, qualification and training. It is the participants’ responsibility to follow the instruction of the activity leader/ staff during the activity and or any emergencies. The participant is responsible for monitoring their own physical condition throughout the duration of this program and should cease participation if any unusual symptoms (such as but not limited to: shortness of breath, dizziness, cramps, dehydration, increase of heart rate, respiratory failure, cardiac arrest, stroke or other injury) occur.
In signing this consent form, I affirm that I have read the above notice carefully and understand the inherent risk of participating in the above program. I hereby assume all risks of damage or injury, including death, that I may sustain while participating in or result of the aforementioned activity. I, along with my family, heirs, personal representatives do hereby waive and release Youngstown State University, the Department of Campus Recreation and their agents and employees for all claims of ordinary negligence, damages, demands, actions or other claims in any manner arising or growing out of my participation in a Department of Campus Recreation program.
I willingly agree to comply with terms and conditions for participation. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.
I, for myself and on behalf of my heirs, assigns, personal representative and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Youngstown State University, its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releases from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES, to the fullest extent permitted by law.
Please Give Completed Form To Your Group Leader - Turn In On Day Of Trip