Participation Agreement and Waiver Form

PROGRAM/ACTIVITY INFORMATION

Program/Activity Name

Date(s)

Location

PARTICIPANT INFORMATION

Name

Address (include city/state/zip)

Phone

Date of Birth

Gender

RELEASE, WAIVER OF LIABILITY, AND COVENANT NOT TO SUE

I (Name) _________________________________, the parent or legal guardian of the Participant, (Name)

____________________________________, for the sole consideration, the sufficiency of which is hereby

acknowledged, of the right to participate in the event or program described as Program/Activity Name (the

Program), do hereby agree to the following relating to the Program.

I fully and voluntarily consent to my child’s participation in the Program. I hereby acknowledge my awareness that

participation in the Program may expose me/my child to risk of property damage, bodily or personal injury.

Participation could include certain physical activities such as [List activities] Examples: swimming, lifting, crossing

streets, parking lots and intersections. I understand that the risks that I/my child may encounter include, but are not

limited to [List risks associated with activities] Examples: transportation accidents, injury from falls, injury in

inclement weather, bumps, bruises, cuts and abrasions, muscle strains and sprains, and exposure to contagious

diseases which may cause death, as well as other risks that may not be foreseeable. I knowingly and freely assume

any and all such risks.

In exchange for being allowed to participate in the Program, I hereby release and forever discharge and agree to

indemnify the [ university / college ], the Board of Regents of the University System of Georgia, its members

individually and their officers, agents and employees from any and all claims, demands, rights, expenses, actions,

and causes of action, of whatever kind, arising from or by reason of any personal injury, bodily injury, property

damage, or the consequences thereof, whether foreseeable or not, resulting from or in any way connected with my

participation in the Program. I further covenant and agree that for the consideration stated above, I will hold forever

harmless and will not take legal action against the [ university / college ], the Board of Regents of the University

System of Georgia, its members individually, and their officers, agents, and employees for any claim for damages

arising or growing out of my participation in this activity whether caused by negligence or otherwise.

I understand that the acceptance of this Release, Waiver of Liability, and Covenant not to sue shall not constitute a

waiver, in whole or part, of sovereign immunity by the Board of Regents of the University System of Georgia, its

members, officers, agents, and employees.

I certify that I understand and have read the above carefully before signing. I acknowledge and represent that I

freely and voluntarily sign this Agreement, and that it is my express intent that this Agreement shall contractually