Waiver and Release of Rights to any and all claims
against
Westfield State College and the Athletics Department
and their
Employees, Athletes, Agents, and Officers
1) I, _______________________________________, of ___________________________
participant’s name street, city, state
_____________________________________________________________________________
street, city, state continued
Realize the possible risks and inherent dangers of the cheerleading clinic in which I am participating, during the date of __________________________________________.
I accept full responsibility for the safety and welfare of my person and property; and I save Westfield State College and the Athletics Department and their employees, athletes, agents, and officers harmless from all liability arising from any injury to my person or for loss, or damage, to my personal property, to the extent allowed under the laws of the Commonwealth of Massachusetts.
2) I accept full responsibility for the consequences of my own conduct and also its effect on other people or property.
3) I certify that I am __________ years of age having been born on the date of:
Birthdate: _____/_____/_____
I have read and understand completely the above terms and conditions, and knowingly and willingly waive and release my rights, as stated, to any and all claims against Westfield State College and the Athletics Department, and their employees, athletes, agents, and officers due to any injury to my person, and/or loss or damage to my personal property sustained while participating in the above stated activity.
__________________________________________ __________
signature date
I, ______________________________________________, the parent/guardian of
print name
________________________________________________, grant permission for my child to
child’s name
participate in the above stated activity. I have read completely, and understand and assent to all the provisions stated herein above.
_________________________________________ ____________
signature date