Da Vinci Club
IN CONSIDERATION of receiving permission from the Da
Vinci Club to use any of its equipment, or engage in any sport, instruction or
observation (“Activity”), whether such activity is organized by the Da Vinci Club or not, I
_____________________________________________ (name of User/Participant) for
myself, my personal representatives, heirs, executors, administrators, agents,
assigns and next of kin:
1. ACKNOWLEDGE,
agree and represent that I understand the nature of the Activity that I am
voluntarily participating in and that I am qualified, in good health and in
proper physical condition to participate in such Activity. I agree and warrant that if at any time I
believe conditions to be unsafe, I will immediately discontinue further
participation in Activity. It is
User/Participant responsibility to consult with his/her physician to determine
if any medical condition exists and, if so, whether such condition poses a
direct threat to the health or safety of User/Participant or others.
2. FULLY UNDERSTAND THAT: (a) Activity may
involve risks and dangers of serious bodily injury, including permanent
disability, paralysis and death ("Risks"); (b) these Risks and
dangers may be caused by my own actions, the actions of others participating in
the Activity, the condition in which the Activity takes place, or the
negligence of the "Releasees" named below; and (c) there may be other
risks and social and economic losses either known to me or not readily
foreseeable at this time.
3. AGREE that if
I engage in any Activity, I do so at my own risk. This includes, without
limitation, use of the locker room, track and field, pool or any equipment and
participation in any activity, class, program or instruction. I agree that I am
voluntarily participating in these activities and using equipment and premises
and assume all risk of injury, illness, damage or loss to myself or to my
property that might result, including, without limitation, any loss or theft of
any personal property. I agree to
release and discharge Caltech, the Da Vinci Club, its directors, officers,
trustees, employees, students, volunteers, agents, and all others (“Releasees”)
from any and all claims or causes of action (known or unknown) arising out of
any negligence. This Waiver and Release of Liability includes, without
limitation, injuries which may occur as a result of (a) use of any equipment or
facilities which may malfunction or break; (b) improper maintenance of any
equipment or facilities, and (c) negligent instruction or supervision. I acknowledge that I have carefully read this
Waiver and Release of Liability and fully understand that it is a release of
liability. I waive any right that I may
have to bring a legal action to assert a claim against Releasees for any
negligence.
4. UNDERSTAND that this release is intended to
be as broad and inclusive as permitted by the laws of
I have read this release and fully understand that by
signing this agreement, I am giving up legal rights and/or remedies that may be
available to me, and am doing so voluntarily.
__________________ ____________________________ ________________
(Signature of
User/Participant) Name of
User/Participant Date
Signed
Please return completed form to:
Alex Bäcker
Da Vinci Club
Fax: 650-618-2560