P
ACTIVITY PARTICIPATION AGREEMENT
This is a legally binding Release made by me,
, to the University of Massachusetts (University).
I fully recognize that there are dangers and risks to which I may be exposed by participating in [insert name of project]
during [insert dates of program]
. The following is a description and examples of specific,
significant, non-obvious dangers and risks associated with this activity: strains, sprains, bruises, broken bones, heat
exhaustion, heart attack, and death.
It is the responsibility of each participant to engage only in those activities and programs for which he/she has the
prerequisite skills, qualifications, preparation, and training. I have made myself aware of the physical requirements
necessary for participation in the above activity, and I certify that I possess all of the necessary physical abilities,
experience, training, and knowledge. I understand that the University does not require me to participate in this activity,
but I want to do so, despite the possible dangers and risks and despite this Release. I am aware that the University does
not provide health or liability insurance of any kind for me, and that I am solely responsible for any medical costs arising
out of my participation in this activity.
ACKNOWLEDGEMENT, ASSUMPTION OF RISK, AND RELEASE
I HAVE READ THE ABOVE NOTICE CAREFULLY. In consideration of the benefits received, I hereby voluntarily
and knowingly ASSUME all risks of damages and injury, including death, which I may sustain while participating in or as
a result of, or in any way arising out of this activity, or in travel to and from such activity.
I therefore agree, in consideration of and return for the services, facilities, and other assistance provided to me by the
University in this activity, to RELEASE the University (and its Board of Trustees, officers, employees, and agents) from
any and all liability, claims and actions that may arise from injury or harm to me, from my death or from damage to my
property in connection with my participation in this activity. I understand that this RELEASE covers liability, claims and
actions caused entirely or in part by any acts or failures to act of the University (or its Trustees, employees, or agents),
including but not limited to negligence, mistake, or failure to supervise by the University.
I recognize that signing this acknowledgement, assumption of risk, and release means I am giving up, among other things,
rights to sue the University, its Trustees, employees, and agents for injuries, damages, or losses I may incur. I also
understand that this Release binds my heirs, executors, administrators, and assigns, as well as myself.
I have read this entire Release. I certify that I am
be legally bound by it.
years old, and that I fully understand this Release and I agree to
THIS IS A RELEASE OF YOUR RIGHTS. READ CAREFULLY BEFORE SIGNING.
(Participant Signature/Date)
(Witness Signature/Date)
(Participant Name)
(Witness Name)
(Parent or Guardian Signature if
Releasor is under 18 years old)
(Date)
(Parent or Guardian Name)
(Parent or Guardian Phone Number)