Student Waiver Form

ACADEMY OF ART UNIVERSITY PARTICIPANT AGREEMENT RELEASE AND ACKNOWLEDGEMENT OF RISK

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In consideration of the participation in the sports programs, activities, games, and/ or services of the Stephens Institute; D.B.A. Academy of Art University, affiliated entities, their agents, owners, directors, officers, volunteers, participants, employees, premises lessors, and all other persons or entities assigned in any capacity on their behalf (hereinafter collectively referred to as "Academy"), I hereby agree to release and discharge Academy, on behalf of myself, my children, my parents, my heirs, assigns, personal representatives and estate as follows:
1. I, , acknowledge that this Academy of Art University sponsored activity/event entails knowing and unanticipated risks, which could result in physical or emotional injury, paralysis, death, or damage to myself, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity.

The risks include, among other things: physical injury, loss of time at school/work, death, or the negligence of other participants, visitors, or other persons who may be present, or my own negligence. Furthermore, Academy employees have difficult jobs to perform. They may give inadequate warning or instructions, and equipment being used might malfunction.

2. I expressly agree and promise to accept all of the risks associated with this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

3. I acknowledge, agree and represent that I understand the nature of said activities and that I am qualified, in good health and have no medical condition preventing my safe participation in any sport activity, program or game. I further agree and warrant that if at any time I believe the conditions to be unsafe for participation, I will immediately discontinue further participation in said activity.

4. I hereby voluntarily WAIVE, RELEASE, DISCHARGE, COVENANT NOT TO SUE, and agree to INDEMNIFY and hold HARMLESS Academy from any and all claims, demands, or causes of action, which are in any way connected with the participation in this activity or my use of Academy's equipment or facilities, including any such Claims which allege any negligent acts or omissions of Academy, except Academy's sole negligence or willful misconduct.

5. Should Academy be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

6. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. If I have insurance, I have read and understood my policy and am aware of the extent of its coverage for injuries and damage that may be sustained while participating in this activity/event. I further certify that I have no medical or physical conditions that could interfere with my safety in this activity, or else I am willing to assume - and bear the costs of - all risks that may arise, directly or indirectly, out of any such condition.

7. I hereby grant full permission to Academy, to use any photographs, images, videotapes, motion pictures, recording, or any other record of the activities or event for any lawful purpose and I understand that I shall not be entitled to any compensation therefore. All photographs, media, resumes, or other submissions taken by or given to the Academy shall be the property of the Academy.

8.I consent to emergency medical treatment in the event such care is required and release, indemnify, and hold harmless the Academy and its agents, employees, officers, directors, affiliates, emergency care providers, successors and assigns, coaches, teachers, and trustees of and from any and all claims, demands, causes of actions, expenses, lawsuits, damages and liabilities, of every kind and nature, whether known or unknown, in law or equity, arising from such emergency medical care or treatment.

9. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a lawsuit against Academy on the basis of any claim on which I have released them herein.

Please double-check your Student ID to ensure it is correct and ensure it begins with a zero (0), like this: 05555555



Emergency Contact





Minor

The undersigned, referred to as parent(s) and natural guardian(s) or legal guardian(s) of , do hereby represent that he/she (they) is (are), in fact, acting in such a capacity and agree to indemnify, save and hold harmless each and all of the parties herein referred to above as Academy from all loss, liability, damage, cost or claim whatsoever that may be imposed upon Academy because of any defect in or lack of such capacity to so act and release Academy on behalf of the undersigned.

I have had sufficient opportunity to read the PARTICIPANT AGREEMENT RELEASE AND ACKNOWLEDGEMENT OF RISK attached hereto. This waiver is freely and voluntarily given with the understanding that any right to legal recourse against the Academy is knowingly given up in return for allowing my minor child to participate in the activity, program or games. My signature on this document is intended to bind not only myself and my minor child, but also our successors, heirs, representatives, administrators, and assigns. I have read and understood this PARTICIPANT AGREEMENT RELEASE AND ACKNOWLEDGEMENT OF RISK, and I agree to be bound by its terms.

Parent/Guardian







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