Stetson University
Recreational Event, Activity or Program
Risk Acknowledgement and Liability Waiver
Name of Event or Activity: Stress-Free Zone: Smash & Bash, Animal Petting
Recreational Activity Dates: May 1st, 2008
Risks Specific to this activity include, but are not limited to:
Puppy/kitten petting: Possible scratches and bites from dogs or cats, allergic reactions
Smash and bash: Physical strain related to swinging a large sledge hammer/softball bat, possible
debris flying from car/copier
Massages: Physical contact, pressure to muscle/bones
Nurf War: Flying debris and foam projectiles, possible slips, trips and falls from running and dodging, possible collision with other players, etc
Upon signing and submitting this form, I acknowledge and certify that my participation in the aforementioned recreational activity is completely voluntary.
I am aware that this recreational activity can be physically challenging and place unusual demands on the body, and understand it is my responsibility to participate only in those activities of which I am physically capable, and/or have the prerequisite skills and training.
Due to the nature of these recreational activities, I acknowledge that my participation could involve risk of bodily injury, illness, death, property damage, or other risks associated with these activities, and I assume full responsibility for such, including those arising from travel to and from such activities.
Medical Coverage:
I agree and acknowledge that Stetson University is not responsible or liable for my health and safety. Recognizing this, however, I wish to, and hereby do, grant Stetson University full authority to take, or not take, in its sole discretion, whatever actions it may consider warranted under the circumstances for my health and safety during my participation in this recreational activity, and I hereby release each of them from any liability for any such decisions or actions as may be taken by them in connection therewith. The authority granted in the preceding sentence shall include the right (in the sole discretion of Stetson University) to place me, at my own expense, and without any further consent, in a hospital, for emergency medical services and treatment, or if no hospital is readily accessible, to place me in the hands of a local medical doctor for treatment.
Liability Waiver:
Stetson University does not warrant or guarantee in any respect the physical condition of any of the equipment or vehicles used in connection with said activities, nor the competency or credentials of any individual participant associated with this program.
Furthermore, in consideration of the opportunity to participate in the above referred activities, with full knowledge and appreciation of the risks involved, and full understanding of the above issues/conditions, I hereby release and hold harmless Stetson University, Inc., its faculty, staff, coaches, officers, trustees, representatives, chaperones, employees, volunteers, and agents from all manner of action and actions, cause and causes of action, suits, claims, or demands of any nature, including personal injuries, damages or property loss resulting from said participation.
I have read and understand the foregoing, and, as necessary, have had the opportunity to have it reviewed by my guardian and/or legal counsel, and hereby agree to be bound by same.
___________________________________ ____________________________________
Participant Signature Date Witness Signature Date
___________________________________ _____________________________
Printed Name of Participant Printed Name of Witness
___________________________________ ___________________________________
Parent/Guardian Signature Date Printed Name of Parent/Guardian
(If participant is under 18 years of Age)
Participant Address & Phone #: ___________________________________________________
_____________________________________________________________________________
Emergency Contact Name:_______________________________ Phone:_________________
(Rev 8/07)