Southwestern University Waiver
for Summer Camp
SOUTHWESTERN UNIVERSITY
ASSUMPTION OF RISK
In consideration of Southwestern
University (the “University”), allowing the
undersigned to participate in certain endeavors,
including, but not limited to, the use of the Corbin
J. Roberson Center, Walzel Gymnasium, Walzel
natatorium, all related facilities and equipment
(collectively “Robertson Center”), and activities
incidental thereto, the undersigned (hereinafter
referred to as “Participant”) hereby agrees to the
following:
1. Participant recognizes and understands that certain
risks of harm are inherent and that there are dangers
involved that cannot be fully foreseen and over which
the University has no control which could result in
property damage, bodily injury or death.
2. Participant understands that there are dangers and
inherent risks in playing or participating in any
fitness activity or sport (such as walking, climbing,
running, stretching, weightlifting, swimming, aerobic
exercise, fitness assessment, stress tests, etc.) that
include, but are not limited to, death, serious neck
and spinal injuries which may result in complete or
partial paralysis, serious injury related to the eye
and/or head, serious injury to virtually all internal
organs, serious injury to all bones, joints,
ligaments, muscles, tendons, and other parts of the
muscular/skeletal system, and serious injury or
impairment to other aspects of my body and general
health and well being.
3. The University strongly suggests that the
Participant seek medical advice prior to engaging in
any fitness activity or sport (such as walking,
climbing, running, stretching, weightlifting,
swimming, aerobic exercise, fitness assessment, stress
tests, etc.), and activities incidental thereto.
4. Participant agrees to assume all risks and
responsibility for any and all claims for damages,
including personal injury or death, and for any
medical expense which may be incurred by Participant
during any fitness activity or sport, and activities
incidental thereto.
5. I have read the above agreement and foregoing and
have willingly signed the same for the consideration
expressed and with a full understanding of its
purpose. Participant represents that he/she is 18
years of age or older or, if not, that his/her legal
guardian is also signing this agreement.
Name of
Participant:____________________________________________
Address of
Participant:__________________________________________
Soc. Sec.# of
Participant:________________________________________
Date:__________
Signature:________________________________
If the Participant is not 18
years of age or older, the signature of the
Participant’s parent or guardian is required.
_________________________________________________________
Parent or Guardian
In case of emergency:
Name:___________________________________________________
Phone
Number:____________________________________________
Address:_________________________________________________
PLEASE PRINT THE REQUIRED WAIVER FORM BELOW
