Acknowledgement of Risks

Name

I understand that participation in Clark College Fitness Trainer, Health & Physical Education class(es), ASCC Intramurals, Thompson Fitness Center, and Open Gym involves inherent risks of injury, and that the nature of the risks may vary depending upon the type of activity, instructor, and my own physical condition and conduct. I also understand that it is not possible to specifically list each and every individual risk. Some activities may expose participants to risks including but not limited to: participation in strenuous exercise; off-campus facilities and locations; activities governed by “rules of the road,” road hazards, uneven outdoor surfaces, vehicle traffic, travel to and from events/locations; exposure to allergens or pathogens, dehydration, animals, effects of weather/environment, acts of nature; cuts, scrapes, bruises, blisters, teeth damage, skin/muscle/bone/joint, head injuries, hernia injuries, lack of rapid responding medical assistance, pool maintenance by an outside agency, choking, drowning, swimmer’s ear (swimming), stabbing (from broken fencing weapon--uncommon), crush and blunt force trauma, actions of other participants, collision with other participants or equipment/implements, exhaustion, falling, fainting, and/or death.

I understand that this course/activity often involve some touching, and that if I am in any way uncomfortable with this physical contact, I will inform the instructor, or any other sponsor of this course/activity, of my discomfort so that accommodations can be made.

I acknowledge that I will either ask for or have been given any information that I need to determine the general risks associated with this course/activity. I recognize and acknowledge that there are both foreseeable and unforeseeable risks of injury or death.

I understand that a written self-evaluation of my health status is available and recommended to help me decide whether a physician should be consulted to determine any potential conditions that may adversely affect participation prior to participating in any physical activity. I understand it is ultimately my responsibility to determine whether I can safely participate in this course/activity. Medical evaluations may be available through Clark College Health Services.

I understand that certain precautions may be advised for the particular course/activity. I agree to follow those precautions and to conform to all rules and policies of the department, the instructor and any other sponsor of this course/activity. However, I recognize that these precautions will not eliminate the risks inherent in the course/activity.

I understand it is my responsibility to provide for my own medical and accident coverage. Clark College does not provide direct medical and accident coverage; however, persons (if eligible) may purchase such insurance coverage by contacting Health Services at 390-992-2264 or the Cashier's Office at 360-992-2177.

If participant is under the age of 18, parent or guardian must complete the following: I have read and understand the above information. I give my permission for my child to participate in this course/activity and grant the same informed consent and acknowledgement of risk on behalf of myself, my child and the child’s family. SIGNATURE OF PARENT OR GUARDIAN DATE __________________

Release of Liability Form

I release Clark College, and the employees, agents, or representatives of Clark College from any and all liability, claims, costs, expenses, injuries, or losses including those resulting from acts of negligence by Clark College that I may otherwise sustain as a result of my participation in or use of the programs, services, facilities, and equipment of the Fitness Center open hours, ASCC Intramurals, and/or open gym times. I also release Clark College from loss or damage to my person or property caused by other users of the Fitness Center, ASCC Intramurals, and/or open gym.

If any part or portion of this Release of Liability is determined to be invalid or unenforceable, the remaining parts or portions shall be enforceable.

I have carefully read this Release of Liability and fully understand its contents. I am aware that this Release of Liability is a contract between Clark College and myself and I sign it of my own free will.

*If the above is a minor (under 18), the minor’s parent or guardian shall sign below.

NOTE: We strongly encourage you to consult with a physician before participating in any physical activity to determine any potential conditions that may adversely affect your participation. We encourage those with pre-existing conditions to wear a medical alert bracelet or neck tag indicating the appropriate medical information. We strongly recommend that all participants have a medical insurance policy, either through college offered programs or through an outside agency that will cover injuries or illness that may occur due to participation in or use of programs, services, facilities, and equipment.

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Clark College Health & Physical Education

Acknowledgement of Risks

Name

Clark College Health & Physical Education

Release of Liability Form