PARENTAL PERMISSION FORM /ACKNOWLEDGMENT OF RISK AND RELEASE
THIS DOCUMENT MUST BE SIGNED BY THE PARENT OR LEGAL GUARDIAN OF PERSONS UNDER THE AGE OF
18 PARTICIPATING IN THE ACTIVITY DESCRIBED BELOW. IF THE PERSON PARTICIPATING IN THE ACTIVITY IS
18 YEARS OF AGE OR OLDER, THEN THE PARTICIPANT MUST SIGN THIS DOCUMENT.
AUTHORIZATION TO PARTICIPATE/ASSOCIATED RISKS: The individual named below as “Participant,” if over the age of 18, or his parent or legal guardian if the Participant is under the age of 18, hereby acknowledges that he or she authorizes Participant to participate in the activity described below, hereto (the “Activity”), and further acknowledges his or her full understanding and appreciation that there are inherent risks of damage or injury associated with participation in the Activity including those risks described below that cannot be eliminated regardless of the care taken to avoid injuries. The undersigned hereby represents that the Participant is in good physical and mental health and has no physical impairment that would be affected by his or her participation in the Activity. Any parent or legal guardian signing further represents that he or she has thoroughly explained to the minor Participant the risks associated with participating in the Activity using language appropriate to the age and intellectual capacity of the Participant.
ASSUMPTION OF RISKS/WAIVER/INDEMNIFICATION AND HOLD HARMLESS: By signing this form, the Participant, or his parent or legal guardian, on behalf of himself, his heirs, assigns, legal and personal representative(s), agrees to assume all risks and responsibilities surrounding Participant’s participation in the Activity and further to release, waive, discharge and covenant not to sue RESCUE A GENERATION, INC., its trustees, officers, representatives, agents and employees (hereinafter collectively “AZUSA PACIFIC UNIVERSITY”) from liability from any and all claims including the negligence of AZUSA PACIFIC UNIVERSITY and/or RESCUE A GENERATION, resulting in personal injury,
accidents, or illnesses (including death) and property loss arising from the Participant’s participation in the Activity. Further, the undersigned on behalf of the Participant, himself, his heirs, assigns, legal and personal representative(s) agrees to indemnify and hold harmless AZUSA PACIFIC UNIVERSITY
and RESCUE A GENERATION from any and all claims, demands, actions, or causes of action (including attorney fees and court costs) on account of damage to personal property, or personal injury, or death which may result from the Participant’s participation in the Activity.
SEVERABILITY: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by California law and that if any portion thereof is held invalid, it is agreed that the balance shall continue in full legal force
and effect.
INSURANCE AND MEDICAL TREATMENT: The undersigned understands that AZUSA PACIFIC UNIVERSITY and RESCUE A GENERATION do not maintain any insurance policy covering any circumstance arising from participation in the Activity or any event related to that participation. As such, the undersigned acknowledges that he/she has adequate health insurance coverage for the Participant’s participation in the Activity. The undersigned hereby authorizes AZUSA PACIFIC UNIVERSITY and RESCUE A GENERATION to act for me according to its best
judgment in any emergency requiring medical attention of the Participant, and I understand that I will be financially responsible for all charges and fees incurred in the rending of emergency treatment.
ACKNOWLEDGEMENT OF UNDERSTANDING: I have read this waiver of liability, assumption of risk and indemnification agreement, fully understand its terms, and understand that I am giving up the substantial rights, including my right to sue. I acknowledge that I am signing this agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
Activity Name: The Takeover
Activity Dates: March 21 - 23
Activity Risks: Including, but not limited to (1) minor injuries such as scratches, bruises and sprains; (2) major injuries such as eye injury or loss of sight, joint or back injuries and concussions; (3) catastrophic injuries including paralysis and death.
