ࡱ> 9;8g (bjbjVV q.r<r< xx$PFb$B0($r$Z-pP|_;)C.0B~q~~vTSD<B~x :  CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS a campus of the California State University % Bakersfield % Channel Islands % Chico % Dominguez Hills % Fresno % Fullerton % Hayward % Humboldt % Long Beach % Los Angeles Maritime Academy % Monterey Bay % Northridge % Pomona % Sacramento % San Bernardino % San Diego % San Francisco % San Jose % San Luis Obispo % San Marcos % Sonoma % Stanislaus RELEASE OF LIABILITY, WAIVER OF RIGHT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activity: ____________________________________________________________________ Activity Date(s) and Time(s): ___________________________________________________ Activity Location/Facility: ______________________________________________________ In consideration for being allowed to participate in this Activity, I release from liability and waive my right to sue the State of California, the Trustees of the California State University, which own and operate California State University, Channel Islands and their employees, officers, volunteers and agents (collectively University) from any and all claims, including the Universitys negligence, resulting in any physical injury, illness (including death) or economic loss that I may suffer because of my participation in this Activity, including any travel to and from the Activity. I am voluntarily participating in this Activity. I understand that there are risks, such as physical and/or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability or even death, which may occur from my participation in this Activity. These injuries or outcomes may arise from my own or others actions, inactions, negligence, or from the condition of the Activity location(s) or facility(ies). Nonetheless, I assume all related risks, whether known or unknown to me, of my participation in this Activity, including travel to and from the Activity. I agree to hold the University harmless from any and all claims, loss or damage to my personal property, liabilities and costs, including attorneys fees, as a result of my participation in this Activity, including travel to and from the Activity. If the University incurs any of these types of expenses, I agree to reimburse the University. If I need medical treatment, the University is authorized to obtain medical treatment for me. I will be financially responsible for any costs of such treatment. I agree that I will not hold the University responsible for any claims resulting from any medical treatment. I am aware that the University does not provide health insurance for me and I should carry my own health insurance. I am 18 years or older. I have read this document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) releasing the University from all liability, (b) waiver of my right to sue the University, (c) and assumption of all risks of participating in this Activity, including travel to and from the Activity. I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. Participant Name (Print): _________________________________ Date: ______________________ Signature: _____________________________________________ One University Drive, Camarillo CA 93012 (805) 437-8400 Fax (805) 437-3366 If Participant is under 18 years of age: I am the parent or legal guardian of the Participant. I have read this two-page document, and I am signing it freely. I understand the legal consequences of signing this document, including (a) release of University from all liability on my and the Participants behalf, (b) waiver of my and the Participants right to sue, (c) and assumption of all risks of the Participants participation in this Activity, including travel to and from the Activity. I allow Participant to participate in this Activity. I understand that I am responsible for the obligations and acts of Participant as described in this document. I agree to be bound by the terms of this document. Name of Minor Participants Parent/Guardian (Print): _________________________ Date: ______________ Signature of Minor Participants Parent/Guardian: ____________________________________ Minor Participants Name (Print): __________________________________________ One University Drive, Camarillo CA 93012 (805) 437-8400 Fax (805) 437-3366 \`dz L P R    F IJl\IA=9=9=5=hmhRhXThXT5>*\$hWW+hWW+@CJ OJQJ^JaJ hWW+@CJ OJQJ^JaJ $h-uhTO @CJ OJQJ^JaJ h-u@CJ OJQJ^JaJ h-uhTO CJ OJQJ^JaJ #h-uhTO 6CJ OJQJ^JaJ #h-uhTO 6CJ OJQJ^JaJ h-u6CJ OJQJ^JaJ hP"hTO @(CJ aJ hP"hTO @(hP"hTO @DCJaJhWW+@DCJaJ\d L N P R   X QS~gdXTdhgd F]$a$gdXTgdTO F w nPQ>~(,./aghjn\_>?E]鶲h-uCJaJhSRshTO h;lhDhXT56\]#h-uhXT>*CJOJQJ^JaJhDCJaJh-uh-uCJaJh-uhmhH;hXT hXT5\@./kmnDEgdTO $a$gdXT$a$gd-ugd-ugdXTgdm$a$gdD$a$gd-ugdTO      Page  PAGE 1 of  NUMPAGES 2 Revd 1/2015 ( ( (((((((((l(m(s(t(u(v(z({(((((((((((λλǯ٫hyZh7lvh7lvCJ\aJhj^5\mHnHu h7lv5\jh7lv5U\h7lvh];jh];U he8hTO CJOJQJ^JaJUhTO  ((((((((((((((gd7lvgd-u;0P:p7lv/ =!"#$%vK Dp21h:p7lv/ =!"#$h% ^ 02 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ TO NormalCJ_HaJmH sH tH DA D Default Paragraph FontRiR  Table Normal4 l4a (k (No List VoV ^Default 7$8$H$!B*CJ_HaJmH phsH tH 44 WW+Header  !4 @4 WW+0Footer  !6o!6 7lv0 Footer CharCJaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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