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RELEASE FROM RESPONSIBILITY, ASSUMPTION OF RISK, AND WAIVER

READ THIS DOCUMENT COMPLETELY BEFORE SIGNING. ITS EFFECT IS TO RELEASE COLORADO STATE UNIVERSITY, ITS GOVERNING BOARD, AND THE STATE OF COLORADO FROM ANY LIABILITY RESULTING FROM YOUR PARTICIPATION IN THE ACTIVITIES DESCRIBED BELOW, AND TO WAIVE ALL CLAIMS FOR DAMAGES OR LOSSES AGAINST THE UNIVERSITY WHICH MAY ARISE FROM SUCH ACTIVITIES EVEN IF THEY RESULT FROM NEGLIGENCE. 

RELEASE FROM RESPONSIBILITY, ASSUMPTION OF RISK, AND WAIVER

I, the undersigned participant, exercising my own free choice to participate voluntarily in the activities described above, and promising to take due care during such participation, hereby acknowledge that I have been informed of the nature of the activities and that I am aware of the hazards and risks which may be associated with my participation in the above-named activities, including the risks of bodily injury, death or damage to property which may occur from known or unknown causes. I understand, accept, and assume all such hazards and risks, and waive all claims against the State of Colorado, The Board of Governors of the Colorado State University System, and Colorado State University, and other persons as set forth above. I understand that I am solely responsible for any costs arising out of any bodily injury or property damage that I may sustain through my participation in normal or unusual acts associated with the above-named activities, regardless of whose fault may be the cause of my injuries or damages, EVEN IF CAUSED BY CARELESSNESS OR NEGLIGENCE, so long as the conduct which caused the injuries or damages was not grossly negligent, or willful and wanton.

Further, I hereby indemnify and hold harmless The Board of Governors of the Colorado State University System and Colorado State University, and their members, officers, agents, employees, and any other persons or entities acting on their behalf, and the successors and assigns for any and all of the aforementioned persons and entities, against any and all claims, demands, and causes of action whatsoever, whether presently known or unknown, of any person who suffers any injury, disability, death or other harm, to person or property or both, as a result of my participation in and/or presence at the above listed activities.

I have had sufficient time to review and seek explanation of the provisions contained above, have carefully read them, understand them fully, and agree to be bound by them. After careful deliberation, I voluntarily give my consent and agree to this Release From Responsibility, Assumption of Risk, and Waiver.

I HAVE READ, UNDERSTOOD AND AGREED TO THE ABOVE TERMS THIS DAY OF May 2, 2025

Signature of Participant:


First Participant's Name

First Name*

Middle Name

Last Name*
First Participant's Date of Birth*
First Participant's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Additional Information

LOCATION OF ACTIVITY: HABIC training locations, placement locations, and event locations



DATE(S) OF ACTIVITY(IES):


START DATE *

END DATE: Ongoing


DESCRIPTION OF ACTIVITIES: Behavioral assessments, training, and volunteering with HABIC




If participant is under the age of 18, his or her parent or legal guardian must also sign:

I am the parent or legal guardian of the participant who has signed above. I have read and I understand the provisions of this document, and acting on behalf of the participant, I consent to the participant taking part in the activities described above, and I fully enter into and agree to the above Release From Responsibility, Assumption of Risk, and Waiver as authorized pursuant to C.R.S. section 13-22-107. 



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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Select one:
CSU STUDENT
NON-STUDENT

CSU STUDENT INSURANCE INFORMATION:

IF STUDENT: I am aware that as a student of Colorado State University, I can purchase accident insurance, either through Colorado State University (if available) or through another insurance carrier or agent, and
have exercised my right to do so.
have not exercised my right to do so.

NAME OF INSURANCE CARRIER:

POLICY NUMBER:

HABIC JUNIOR HANDLER INFORMATION:

IF JUNIOR HANDLER:
I confirm that I am at least 16 years of age and have received approval from HABIC staff to participate in HABIC activities.
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.


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