NAME OF ACTIVITY_____________________________________________________


NAME OF PARTICIPANT_________________________________________________


DATE OF BIRTH____________________




CITY, STATE, ZIP_______________________________________________________


I,_______________________________, acknowledge that I have voluntarily chosen to participate in the above referenced activity and I have full knowledge of the risks that this activity presents, including travel to, participation in, and returning from the activity. I am aware that portions of this activity are not guided or supervised by the College.


I understand that by being permitted to participate in this activity, I agree to assume any and all risk of injury or death. I further understand and agree to assume responsibility for risk of theft, loss, or damage to my personal property, which may occur at any time arising out of my participation in this activity.


I understand and agree that as a condition of participation in this activity, I will release from liability and will indemnify the member institutions of The Claremont Colleges, their officers, directors, agents, employees, assigns, successors, or lessors for any damage, injury, or death to myself or any other persons or property, in any way connected with my participation in this activity. I understand that there exist specific hazards associated with this activity, to include injury and/or death, and I accept full responsibility for these hazards.


I have carefully read this agreement and fully understand all of its terms and conditions. I understand that this is a release of liability, which could legally prevent me from filing a law suit or making any other legal claim for damages in the event of my death or injury. With this knowledge, I am entering into this agreement fully and voluntarily. I agree that the agreement is binding upon me, my spouse, my heirs, my children including any guardian ad litem for the children, my assignees, and legal representatives.


I understand and agree that if I am signing this waiver and release on behalf of my minor child that I am giving up the same rights for the minor as I would be giving up if I signed this document on my own behalf.


I understand and agree that I have read this entire waiver and release, have been provided with all necessary information, and I agree with the terms and conditions. The Claremont Colleges does not provide insurance coverage for club participants for injuries occurring while participating in play or practice of club/intramural activities.  Any injury claim must be filed with the students' own group insurance.  Prior to participation, participants must review their own private coverage and understand the coverage and limitations of their personal policy in regards to extracurricular activities.  We, the undersigned, have reviewed our personal insurance policies and understand that the Claremont Colleges and the Club Sport Program are not responsible for any injury sustained by participants associated with the Club Sport Program.


DEFINITION OF TERMS: As used in this document, member institutions are defined as Claremont Graduate University, Claremont McKenna College, Claremont University Consortium, Harvey Mudd College, Keck Graduate Institute, Pitzer College, Pomona College and Scripps College.




PARENT/GUARDIAN SIGNATURE________________________________________