Loading...

Individual Participant Waiver and Release Agreement, Adventure Program 

The undersigned in consideration for the right to participate in our Outdoor Program (OP) workshop, class, clinic, event or trip, hereby agrees to this waiver and release.

I recognize that the Activity may have a risk of personal injury and/or damage to my property. I hereby freely assume all risks which may be associated with or result from participating in the Activity including, but not limited to:

1. Travel to and from, instruction, participation, and competition.

2. Risks involved in physical activity. These activities may include running, sliding, jumping, falling, hiking, biking, snow travel, climbing, paddling, and repetitive lifting. These activities may take place at day or night and visibility may be significantly reduced.

3. Objective Risks present in an outdoor environment. These risks include travel where trails or routes may not be groomed, maintained, or controlled, or where trails do not exist. While traveling in these areas, hazards may not be marked or visible; weather is changeable, unpredictable and dangerous year-round. Many environmental risks are present and may include lightning, storms, swift-moving water, falling rocks, snow, and ice, avalanche dangers, fallen timber, bees and other stinging insects, wild animals, and other natural hazards and dangers that do not typically exist in an urban setting. Other risks may be present due to negligent behavior, or poor judgment from other parties not associated with Weber State University.

4. Subjective Risks in decision-making. The OP staff must make various judgments and decisions as they conduct educational and/or adventure activities in changing indoor and outdoor environments. These judgments and decisions are, by their nature, imprecise and subject to error. Consequently, there are risks involved in staff decision-making and conduct, including, without limitation, the risk that an OP representative may misjudge a participant’s capabilities, weather, terrain, water level, route location, environmental hazard, or medical treatment

5. Risk of equipment failure. Equipment used may break, fail, or malfunction, despite reasonable maintenance and use.

6. Risks connected with geographic location. OP activities may take place in remote places, several hours or days from any medical facility, where communication and transportation are difficult, where evacuation or medical care may be significantly delayed, and where advanced medical care may be impossible.

7. I authorize and release to the OP the use of my image in any photograph, audio recording, or video recording for any purpose of the OP with no compensation of any kind afforded to me.

8. Because certain activities are contraindicated with certain medical conditions, I affirm that if I have any mental or physical conditions or limitations that might compromise or affect my ability to participate in OP activities, I have discussed them with a licensed physician. Furthermore, if my physician or I feel it is important to share this medical condition with the OP and/or its staff, I will do so.

9. I agree that the OP has no responsibility for medical care provided to me, and I agree to pay all costs associated with such care. Medical services may be limited or unavailable.

10. I understand that the above description of risks is not complete and that other unknown or unanticipated risks, hazards, and dangers may result in injury, damage, death, or other loss. I acknowledge that participating in these activities may require a degree of skill and knowledge different from other activities and that I have responsibilities as a participant to acknowledge my own limitations and take responsibility for my own acquisition of relevant skills and knowledge. I understand that such risks simply cannot be eliminated without jeopardizing the essential quality of the activity. I hereby freely assume all risks which may be associated with or result from participating in the Activity.

I further agree to release the State of Utah, Weber State University (WSU), their officers, employees, agents, contractors and volunteers (“Releasees”) from any and all liability, claims, demands, actions, loss, claim, damage, injury, illness, or harm (“Claims”) to me of any kind or nature arising out of participation in the Activity including where Claims occur due to the negligence of Releasees.


CONSENT

Consent is expressively given, in the event of injury, for any emergency aid, anesthesia, and/or operation, if in the opinion of the attending medical provider, such treatment is necessary.

I AM 18 YEARS OF AGE OR OLDER, HAVE CAREFULLY READ AND UNDERSTAND THE CONTENTS OF THE FOREGOING WAIVER AND RELEASE, AND I SPECIFICALLY INTEND IT TO COVER MY PARTICIPATION OR COMPETITION IN THE ABOVE DESCRIBED EVENT.

*If participant is under 18 do not sign below, please use the informed consent below which must also be signed by a parent or legal guardian.


Today's Date: November 23, 2024

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

W#
Please select applicable:
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

W#
Please select applicable:
Second Participant's Signature*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

W#
Please select applicable:
Third Participant's Signature*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

W#
Please select applicable:
Fourth Participant's Signature*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

W#
Please select applicable:
Fifth Participant's Signature*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

W#
Please select applicable:
Sixth Participant's Signature*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

W#
Please select applicable:
Seventh Participant's Signature*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

W#
Please select applicable:
Eighth Participant's Signature*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

W#
Please select applicable:
Ninth Participant's Signature*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

W#
Please select applicable:
Tenth Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Informed Consent for Minors and their Parent

This is an informed consent form for minors, which identifies risks of participating in a Weber State University (“WSU”) activity or program, and a consent form for parents/guardians.

Parent or Guardian, read and sign this section: I have been informed of the nature of the Activity, listed in this document (see bullet points 1-10), which my minor child wishes to participate in. I recognize that the Activity may involve moderate to strenuous physical activity and may cause physical and or emotional distress to participants. I state that my minor child is free from any known heart, respiratory or other health problems that could prevent her or him from safely participating in the Activity. I consent to the participation of my minor child in the Activity.

CONSENT

Consent is expressively given, in the event of injury, for any emergency aid, anesthesia, and/or operation, if in the opinion of the attending physician, such treatment is necessary.

Participating minor child will read and sign this section: I desire to participate in the Activity described above. I agree to familiarize myself with the Activity and what is required, rules of conduct and safety equipment. I agree to follow proper operating procedures including safety procedures as outlined by the Activity leader, plus any directions given by WSU personnel. I agree to follow the rules of conduct and use the provided safety equipment.



By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

W#
Please select applicable:
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE! and  Rock Gym Pro