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 California, and agree that if any portion is held invalid, the remainder of this release will continue in full force and effect.


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