Lois Rhame West Health, Physical Education and Wellness Center
Waiver of Liability and Release Form
PLEASE READ THE FOLLOWING CAREFULLY. IF YOU HAVE ANY
QUESTIONS, HAVE THEM ANSWERED BEFORE YOU SIGN THIS DOCUMENT.
In consideration of being permitted to use the Lois Rhame West Health, Physical
Education and Wellness Center I, in full recognition and appreciation of the risk inherent
in using the facility, do hereby agree to indemnify, defend, and hold harmless the West
Center/Winthrop University, its trustees, officers and employees from all demands,
claims, suites, actions, or liabilities resulting from injuries or death to any persons or loss
to any property, regardless of cause of incident, caused by or occurring as a result of the
convert or other use of this facility.
I agree in using the facility to abide by all policies and procedures regarding use
of the facility including the West Center Conduct Policy which states all students, guests
and individuals are expected to conduct themselves properly and respect staff directives
while using the West Center. All users must follow West Center policies and procedures
and abide by the Student Conduct Code and all local, state and federal laws. Individuals
involved in any behavior in violation of the West Center Policies and Procedures, for
example, fighting and destruction of property, will automatically forfeit their privileges to
use the facility. Any suspended individual must meet with the West Center Director to be
considered for reinstatement.
I agree to pay costs of repair or replacement for any and all damages of whatever
origin or nature, which may occur as a result of my use of the facility. I further declare
that I am physically fit and capable to participate in activities within the facility. I
acknowledge that I have carefully read this document and that I sign freely and
voluntarily.
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Participant Name (Please Print)
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Date
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Signature of participant
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Date