University of
San Diego, August 7-12 + Aug. 13 conference, 2016: 9:00 a.m. to 4:00 p.m.
AGREEMENT & RELEASE OF LIABILITY
Name of
Participant_________________________________ ___________________________
Home
Address ___________________________________________________________________________
Street Address City State Zip code
The parent or
legal guardian of the participant (“Participant”) should complete and sign this
Agreement and Release of Liability (“Agreement”) since the Participant is under
age 18.
I, the
undersigned, parent/guardian of the Participant, understand that this is a
legally-binding agreement and release of liability of the University of San Diego (USD).
I request
permission for the Participant to participate in the STEAM Team Summer Academy
identified above. In consideration of permission being granted to the Participant
to participate in the workshop activities, I agree as follows:
1. Voluntary
Activity: I understand
and agree that the Participant’s participation in the workshop activities is
purely voluntary and is not required by USD.
2. Release of
Liability: I, on behalf
of the Participant, the Participant’s heirs, personal representatives,
guardians, successors, and assigns, hereby release USD and its administrators,
faculty, trustees, officers, directors, employees, volunteers, and agents, as
well as any other organization through which Participant is participating in
the workshop activities and their respective employees and agents (all of whom
are referred to as “Releasees”) from, and agree not
to sue Releasees, for any claims, loss, liability,
demands, causes of action, costs, expenses (including but not limited to
attorneys’ fees), damages or suits of any type, whether in law or in equity,
that the Participant may have arising from, or relating in any way (directly or
indirectly) to the Participant’s participation in the workshop activities,
including without limitation any physical, emotional or mental injury or
property damage that the Participant may suffer as a result of the Participant’s
participation in the workshop activities, to the maximum extent permitted by
law.
3. Emergency
Medical Treatment I understand and agree that USD does not have medical personnel
available at the location of the workshop activities. I hereby grant USD
permission to authorize emergency medical treatment, if necessary, and to
transport the Participant to an appropriate facility to receive emergency
medical treatment, and that such action shall be subject to the terms of this
Agreement. I understand and agree that USD assumes no responsibility for any
injury or damages which might arise out of, or in connection with, such
authorized emergency medical treatment.
4. Fitness to
Participate I hereby represent that the Participant is physically and mentally
able to participate in the workshop activities and that the Participant has no
health problems or physical or mental conditions that would present a risk to the
Participant or to others.
5. Insurance I represent
that the Participant is covered by a comprehensive medical plan (health
insurance) necessary to provide and pay for any and all medical costs
(including but not limited to transportation costs associated with obtaining
medical care) and/or I will assume all responsibility for medical costs
incurred as a result of illness and/or as a result of the Participant’s
participation in the workshop activities. I agree to pay for any costs related
to the Participant’s medical treatments that are not covered by insurance or if
the Participant has no medical insurance.
6. Compliance with Policies. I
have read and agree that I and the Participant will comply with all applicable
University policies and procedures, including but not limited to those that
apply to participation in the Workshop. I understand that permission to
participate in the Workshop may be suspended, revoked or denied by the University
in its sole and complete discretion. If the Participant observes a hazard
during participation in the Workshop, the Participant will immediately remove him/herself
from participation and bring the hazard to the attention of a University staff
member.
7. Miscellaneous. The law of the state of
California shall govern the validity, construction and enforceability of this Agreement,
without giving effect to its conflict of law principles. The venue for any
dispute relating in any way to this Release shall be in San Diego, California.
If any clause or provision of this Agreement is held to be illegal, void or
voidable as against public policy or otherwise, the invalidity shall not affect
other provisions or parts thereof which may be given effect without the invalid
provision or part. To this extent, the provisions, and parts thereof, of this
Release are severable.
I acknowledge
that I have carefully read this Agreement and fully understand its contents. I
acknowledge that I am voluntarily executing this Agreement of my own free will
after having the opportunity to consult with legal counsel of my own choosing.
I understand that this Agreement means the Participant is giving up, among
other things, rights to sue USD and Releasees for
injuries, damages or losses I or the Participant may incur. I also understand
that this release binds the Participant, as well as the Participant’s heirs,
executors, administrators, and assigns. I further acknowledge and understand
that this Agreement will absolve and release the University of San Diego and Releasees from any liability in connection with any injury
or harm suffered as a result of the Participant’s participation in the workshop
activities. I acknowledge that I have been made aware of any and all risks of
participation in the workshop activities.
I have read
and understand that this Agreement is a release of legal rights and claims.
__________________________________________________________________________________________________
Participant’s
Signature Date
I further
state that I am the Participant’s parent/guardian, and am fully competent to
sign this Agreement; and that I execute this Agreement for full, adequate, and
complete consideration fully intending for myself, for the Participant, and for
the Participant’s family, estate, heirs, administrators, personal
representatives, or assigns to be bound by same.
__________________________________________________________________________________________________
Parent’s/Guardian’s
Signature Date
(required if under 18 years of age)
__________________________________________________________________________________________________
Parent’s/Guardian’s Name (please print) Phone
number
I authorize my child to be transported to and from Sky High
Sports, the Trampoline Place, for a Fieldtrip via university transportation.
__________________________________________________________________________________________________
Parent’s/Guardian’s
Signature Date
(required if under 18 years of age)