RCUH Policies and Procedures
ASSUMPTION OF RISK, RELEASE, AND INDEMNIFICATION AGREEMENT
[NOTE: For purposes of this Assumption of Risk, Release, and Indemnification Agreement (“Agreement”), the term “I” refers to both the Participant and the Participant’s Parent/Legal Guardian, if the Participant is under eighteen (18) years of age.]
I, _______________________________________, understand that I will be participating in the above-described
(print Participant’s name)
activity on enter date(s) at name of location. I understand, acknowledge, and am fully aware that there are inherent dangers and risks involved with my participation in this activity (including the transportation to and from this activity), which may result in illness, personal injury, or death. I agree to strictly follow all safety procedures and guidelines.
In consideration of the Participant being permitted to participate in the above-referenced activity:
I agree, for myself, my heirs, assigns, executors, and personal representatives, to hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the Research Corporation of the University of Hawai‘i and its Board of Directors, officers, employees, agents, and assigns (collectively “RCUH”), and the University of Hawai‘i and its Board of Regents, officers, employees, agents, and assigns (collectively “UH”), from any and all claims including, but not limited to, claims for property damage, personal injury, illness, or death, arising from my involvement or participation in the above-referenced activity.
I also agree to DEFEND, INDEMNIFY, HOLD HARMLESS, RELEASE, AND FOREVER DISCHARGE the RCUH and UH from and against any and all claims, demands, actions or causes of action, on account of any loss, including damage to personal property or personal injury or death, which arise out of my involvement or participation in the above-referenced activity, and which result from causes beyond the control of and without the fault or negligence of the RCUH and UH during the period of my participation in the above-referenced activity.
I also agree that this Agreement shall be construed in accordance with the laws of the State of Hawai‘i, and that if any portion of this Agreement is determined to be invalid by a court of competent jurisdiction, the remainder will continue in full legal force and effect.
I understand and agree that the RCUH and UH do not provide health insurance or otherwise indemnify individuals with respect to injuries or other liabilities arising out of participation in the above-referenced activity.
I have read this Agreement and I understand that I am giving up substantial rights, including the right to sue. I acknowledge that I am signing this Agreement voluntarily and of my own free will, and that no oral representations, statements, or inducements have been made. I am fully competent, and I execute this Agreement for full, adequate, and complete consideration.
(co-signature of parent/guardian required
if Participant is under 18 years of age)
Participant Signature Date
Parent/Legal Guardian Signature Date
MEDICAL CONSENT FORM
[NOTE: For purposes of this Medical Consent Form, the term “I” refers to both the Participant and the Participant’s Parent/Legal Guardian, if the Participant is under eighteen (18) years of age.]
I, the undersigned, consent to and authorize any medical professional and others working under his/her supervision to treat me for any injury or illness arising from or related to my participation in enter activity, on enter date(s).
I further agree to pay any and all medical expenses, costs and other charges, and to release, hold harmless, and forever discharge the Research Corporation of the University of Hawai‘i and its Board of Directors, officers, employees, agents, and assigns, and the University of Hawai`i and its Board of Regents, officers, employees, agents, and assigns, from and against any liability and any claims or demands arising from or connected with such medical treatment or care.
IN CASE OF EMERGENCY:
First Person to Contact: ____________________________ Phone: ___________________
Second Person to Contact: _________________________ Phone: ___________________
Physician to Contact: ______________________________ Phone: ___________________
Signature of Participant Date Print Name
Signature of Parent/Legal Guardian Date Print Name
(required if the Participant is under 18 years of age)