University of California, Irvine
Waiver/Release Agreement
Participation in voluntary University events may require the use of a "Waiver/Release Agreement". Examples of these types of activities include field trips which are not mandatory as part of the class curriculum and recreational and athletic events. It is the responsibility of the department to maintain a copy of the signed Waiver forms. If you need assistance in determining the appropriate use of this form please contact Rick Coulon at x47419.
WAIVER/RELEASE AGREEMENT
I understand that there are risks and dangers inherent in
participating and/or receiving instruction in (Name of Activity) , hereinafter
"Activity". I also understand that in order to be allowed to participate and/or
receive instruction in Activity, I must give up my rights to hold The Regents of the
University of California liable for any injury or damage which I may suffer while
participating and/or receiving instruction in Activity.
Knowing this, and in consideration of being permitted to
participate and/or receive instruction in Activity, I hereby voluntarily release The
Regents of the University of California from any and all liability resulting from or
arising out of my participation and/or receipt of instruction in Activity.
I understand and agree that I am releasing not only the
entities set forth in the paragraph above, but also the officers, agents, and employees of
those entities.
I understand and agree that this Waiver/Release will have
the effect of releasing, discharging, waiving and forever relinquishing any and all
actions or causes of action that I may have or have had, whether past, present or future,
whether known or unknown, and whether anticipated or unanticipated by me, arising out of
my participation and/or receipt of instruction in Activity, except for the acts or
omissions of The Regents of the University of California, its officers, agents or
employees which are found to be negligent by a court of competent jurisdiction.
I understand and agree that this Waiver/Release applies to
personal injury, property damage, or wrongful death which I may suffer, even if caused by
the acts or omissions of others.
I understand and agree that by signing this Waiver/Release,
I am assuming full responsibility for any and all risk of death or personal injury or
property damage suffered by me while participating and/or receiving instruction in
Activity.
I understand and agree that this Waiver/Release will be
binding on me, my spouse, my heirs, my personal representatives, my assignees, my children
and any guardian ad litem for said children.
I understand and agree that by signing this Waiver/Release,
I am agreeing to release, indemnify and hold The Regents of the University of California,
its officers, agents or employees harmless from any and all liability or costs, including
attorneys fees, associated with or arising from my participation and/or receipt of
instruction in Activity.
I understand and agree that if I am signing this
Waiver/Release on behalf of my minor child, that I will be giving up the same rights for
said minor as I would be giving up if I signed this document of my own behalf.
I acknowledge that I have read this Waiver/Release
Agreement and that I understand the words and language in it. I have been advised of the
potential dangers incidental to participating and/or receiving instruction in Activity .
Dated: _________________________,19________
Print Name: ____________________________________
Sign Name: ____________________________________
Witness: ____________________________________
Parent/Guardian Release:
I am the parent or legal guardian of the minor ___________________________, and I am
signing this Waiver/Release on behalf of said minor.
Print name of Parent: _____________________________________
Signature of Parent: _______________________________________
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Maintained by
Rebecca Riggs (rwriggs@uci.edu)
Last Modified 11/27/00