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Adult Liability Waiver
Adult Liability Waiver
*Indicates a required field.
Student Participant Name
High School Name
Parent or Guardian Name
Program and/or Course: UofU / Bridge Program
Dates of Program: 2016-2017 Academic Year
Assumption of Risk
I am the parent/guardian of the above named Participant who is under 18 years of age. I am familiar with the curriculum and the activities which take place in the above named Program and hereby give consent for the Participant to participate in the Program. I understand that participation in the Program can include foreseeable and unforeseeable risks and other hazardous activities inherent in the program, which may expose the participant to illness, injury or death.
Waiver and Release and Indemnification
Participant has been advised to maintain health & accident insurance to cover teh costs of treatment in teh event of any injury or illness
Participant's Insurance ID number
Insurance Carrier Address
Insurance Carrier Phone Number
I understand and acknowledge that the University of Utah ("University") is not an insurer of my behavior, actions or participation in the Program, and that the University assumes no liability whatsoever for personal injuries or property damages to me or to third persons arising out of my participation in the Program activities. I hereby agree to release, waive, covenant not to sue, indemnify and hold harmless the University, and all of their officers, employees and agents (collectively the "Releasees") from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me or loss or damage to any property belonging to me arising out of or related to participation in the above named Program, and excepting only such loss, damage or injury as may be caused by the sole negligence of any Releasee.
I do not have any heart, respiratory or other health conditions that would prevent my safe participation in the Program.
I have adequate health insurance to cover the costs of treatment in the event of any injury (provide health insurance information below).
I agree that the site of any lawsuit arising out of or related to participation in the Program shall be Utah and that this Agreement will be governed by and construed in accordance with the laws of the state of Utah, without application of any principles of choice of law.
I shall pay any attorney fees or costs incurred by the University in enforcing this Agreement.
If any portion of this Agreement is held to be invalid by a court of law, then it is agreed and intended that all the remainder shall, notwithstanding, continue in full force and effect.
I am signing this Agreement for myself as Participant. I acknowledge that I am at least eighteen (18) years of age and I understand the terms of this Agreement. I also acknowledge that this Agreement shall bind my heirs and personal representatives.
Last Updated: 2/9/17