UNIVERSITY OF ILLINOIS AT CHICAGO
DEPARTMENT OF INTERCOLLEGIATE ATHLETICS
FACILITY-USE
WAIVER AND RELEASE
ACCEPTANCE OF RISK AND ACKNOWLEDGEMENT OF RESPONSIBILITY
The University of Illinois at Chicago, Department of Intercollegiate Athletics is providing me with access to and use of certain Athletic Facilities at the University of Illinois at Chicago.
I understand that use of the Facilities may involve my participation in activities or programs requiring physical exertion and that, as with any activity or program involving physical exertion, there are certain inherent risks to personal health, safety and/or property associated therewith. I understand that I should not participate in any said activities or programs unless I am willing to accept the associated risks. I understand that the University of Illinois cannot guarantee my health and safety while participating in these activities or programs. I further understand that my failure to acknowledge and accept these risks will disqualify me from gaining access to and use of the said Facilities. As such I agree as follows:

I understand that there are certain risks associated with access to and use of UIC’s
Athletic Facilities and that the UIC cannot control these risks.

I understand that these risks may include physical injury, death, damage or loss to me and/or my property.
 I also understand that engaging in activities through the use of UIC’s Athletic Facilities could cause injury or harm to a person other than myself. In the event that while participating in an activity I cause harm to another person or another person’s property I accept sole responsibility for my actions.

I understand that the University of Illinois is not responsible or liable for any personal property which may be lost, damaged or stolen while accessing or using the Facilities.

I understand that the University of Illinois is not in a position to guarantee my personal health or safety while accessing and using the Facilities.
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I understand that the University of Illinois does not provide medical, property or personal liability insurance for me or my family and that it is my responsibility to maintain health and hospitalization insurance as a condition of my receiving and using the Facilities. I understand that I may be asked to provide proof of that insurance at any time by UIC.

I consent to medical treatment in the event of injury, accident and/or illness during activities. In the event I am injured or become ill during activities I understand and agree that I accept responsibility for any medical bills, including co-payments and deductibles.
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I further acknowledge/confirm that the University of Illinois is not responsible for any lost time or lost wages I may suffer as a result of my participation in activities through the use of the University’s Athletic Facilities.

I understand and acknowledge that I assume all risks associated with my use of the
Facilities.
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In consideration of being granted access and use of the Facilities, I hereby release, indemnify and hold harmless the University of Illinois at Chicago, its Board of Trustees, officers, agents, employees, volunteers, executors, heirs and assigns of and from any and all claims arising out of or in any way connected with that access/use, including but not limited to the risks outlined above. I will not seek reimbursement from the University of
Illinois unless it is the sole negligence of the University of Illinois that caused my loss.

I further understand that I must obey UIC’s rules and regulations associated with the access to and use of the Facilities and I agree to do so. I acknowledge that UIC may immediately remove me from the Facilities and/or invalidate my temporary Facility-Pass if I violate any of those rules or regulations.


I understand that my right to access and use the facilities under my temporary Facility-
Pass is not transferable and that, if said pass is misused or presented for access and use of the facilities by any person other me, it shall be confiscated by UIC. Further my involvement in such misuse, may subject me to criminal prosecution.

I acknowledge that UIC maintains the right to inspect my temporary Facility-Pass and to ask me for another form of identification to ensure that the I.D./pass is being used by the person to whom it is issued. I understand that UIC maintains the right to deny me access to the Facilities if I do not possess the temporary Facility-Pass and a current picture I.D.

I understand and agree that, should I choose to bring security personnel with me while using the facilities, I am responsible for the actions of those security personnel. I hereby agree to indemnify the University of Illinois for any and all claims arising out of or in any way connected to the actions or behavior of my security personnel.

I certify that I am at least 18 years of age and that I have read and fully understood this
Waiver and Release. If I am under 18 years of age, My parent or legal guardian has read and fully understood this Waiver and Release.
I further state that I have carefully read the foregoing Waiver and Release, that I know and understand the contents thereof, and that I sign the same as my own free act and deed.
User Name (please print)
User Signature
For Parents/Legal Guardian’s of Participants under 18 years of age:
Date
As Parent or Legal Guardian, I state that I have carefully read the foregoing Waiver and Release, that I know and understand the contents thereof and have explained them to my son/daughter. I give my son/daughter permission to participate and use said Facilities and that I sign this
Waiver/Release as my own free act and deed.
Parent/Guardian’s Name (please print)
Parent/Guardian’s Signature
Student /Parent/ Legal Guardian Signature
Date
In the event of an emergency, I give permission to the UIC to contact:
Name
( )
Phone
Date