Clark College Acknowledgement of Risks

Event Title Alternative Spring Break
Event Date Apr. 01, 2014- Apr. 05, 2014
Instructor Weinberger
Course n/a
Term 2014
Date: Apr 23, 2014
Event Description:
10 students will have the opportunity to volunteer in Seattle, Washington with the Clark College Volunteer and Service-Learning Program on an Alternative Spring Break trip. Students will volunteer with the Boys and Girls Club of King County at three different BCG sites: Sacajawea, View Ridge, and Wallingford Boys and Girls Club. Lodging and activities will be provided to students by the VSL Program.
 
Student ID# - Numbers only, no dashes (Example: 9401234567)
Acknowledgement of Risks Form
This activity 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.

Possible risks associated with this activity may include but are not limited to:
  • Exposure to allergens or pathogens
  • Emotional and psychological trauma
  • Theft
  • Accidents related to traffic/transportation
  • Sun and other elements
  • Acts of nature
  • Behavior of others
  • Exposure related to public contact
  • Bruising, muscle soreness and strain

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 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 360-992-2264 or the Cashier's Office at 360-992-2177.
I voluntarily assume all risks of loss, damage, illness, or injury which I may sustain while participating in this course/activity, including travel and usage of any equipment or facilities.
I have informed my instructor in writing of any medical, physical, and or emotional concerns that I have regarding this activity.
If any portion of this Acknowledgement of Risk is determined to be invalid or unenforceable, the remaining parts or portions shall be enforceable.
I have carefully read this Acknowledgement of Risks and fully understand its contents. I am aware that this Acknowledgement of Risks is a contract between Clark College and myself and I sign it of my own free will.
Waiver & Release of Liability
In consideration of Clark College furnishing services and/or equipment to enable me to participate in the #activity# activities at Clark College, I agree as follows: I fully understand and acknowledge that activities and use of equipment/materials have:
  • (a) inherent risks, dangers and hazards as such exists in my participation in #activity#;
  • (b) my participation in such activities and / or use of such equipment may result in injury or illness including but not limited to bodily injury, allergic reaction, cuts, scrapes, bruises, or other ailments that could cause serious disability including death ;
  • (c) these risks and dangers may be caused by the negligence of the owners, employees, officers or agents of Clark College, the negligence of the participants, the negligence of others. Accidents, breaches of contract, the forces of nature or other causes. Risks and dangers may arise from foreseeable or unenforceable causes including, but not limited to, equipment operator decision making. Weather, location, risks of falling and such other risks, hazards and dangers that are integral to recreational activities that take place in an educational environment; and
  • (d) by my participation in these activities and/or use of equipment, I hereby assume all risks and dangers and all responsibility for any losses and / or damages whether caused in whole or in part by the negligence or other conduct of the owners, agents, officers, or employees of Clark College, or by any other person.
I, on behalf of myself, my personal representatives and my heirs hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify Clark College and its owners, agents, officers, and employees from any and all claims, actions or losses for bodily injury, property damage, wrongful death, loss of services or otherwise which may arise out of my use of recreational equipment or my participation in the above mentioned activity/program at Clark College. I specifically understand that I am releasing, discharging and waiving any claims or actions that I may have presently or in the future for the negligent acts or other conduct by the owners, agents, officers or employees of Clark College.
I have read the above waiver and release and by checking it agree. It is my intention to exempt and relieve Clark College from liability for personal injury, property damage or wrongful death caused by negligence or any other cause.
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.
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