Clark State Wellness Center Informed Consent, Voluntary Waiver, Release of Liability and Assumption of Risk Form

PLEASE READ THIS DOCUMENT CAREFULLY BEFORE SIGNING.  THIS IS A LEGALLY BINDING DOCUMENT.  THIS FULLY SIGNED FORM MUST BE SUBMITTED BY PARTICIPANT BEFORE PARTICIPANT IS ALLOWED TO USE THE CLARK STATE COLLEGE WELLNESS CENTER’S EQUIPMENT AND FACILITIES.

I, the undersigned, wish to be permitted to use the Clark State College Wellness Center’s equipment and facilities (hereinafter “Activity”) and, in consideration for my engagement in Activity, I hereby agree as follows:

I acknowledge, understand and appreciate that as part of my engagement in the Activity, there are dangers, hazards and inherent risks to which I may be exposed, both known and unknown, including the risk of serious physical injury, temporary or permanent disability, and death, as well as economic and property loss and have elected to engage in the Activity.  I voluntarily accept and assume all risk of injury, loss of life to myself or damage to my property arising out of engaging in the Activity.

I agree to be solely responsible for safety and wellbeing of myself and my guest.  I understand that Clark State College does not provide supervision, instruction, or assistance for the use of the equipment and facilities.  I agree to comply with all rules imposed by Clark State College regarding the use of the equipment and facilities. 

I hereby release the State of Ohio, Clark State College, its Board of Trustees, Administration, Faculty, Staff, Student Leaders, and all other officers, directors, employees, volunteers and agents (hereinafter “Clark State College”) from any and all liability as to any right of action that may accrue to my heirs or representatives for any injury or loss that I may suffer while engaging in the Activity.  This agreement is binding on my heirs and assigns.

I furthermore release, indemnify and hold harmless Clark State College from and against any and all liability, claims, demands, and causes of action whatsoever, whether presently known or unknown, either in law or in equity, relating to injury, disability, or death or other harm, to my person or property or both, arising from my engagement in the Activity.  I understand that Clark State College accepts no responsibility for my personal property.

I certify to Clark State College that I have no known medical problems or conditions that would prevent me from engaging in the Activity.  In the event of an accident or serious illness, I hereby authorize representatives of Clark State College to obtain medical treatment on my behalf.  I hereby hold harmless and agree to indemnify Clark State College from any claims, causes of action, damages and/or liabilities, arising out of or resulting from said medical treatment.  I acknowledge that Clark State College does not provide health and accident coverage to me and I attest that I have adequate health insurance necessary to provide for and pay any medical costs that may be attendant as a result of any injury that I may sustain.  I further agree to accept full responsibility for any and all expenses, including medical expenses that may derive from any injuries to my person that may occur during my engagement in the Activity.

This RELEASE shall be governed by and construed under the laws of Ohio.

This RELEASE contains the entire agreement between the parties to this agreement and the terms of this RELEASE are contractual and not a mere recital. The information I have provided is disclosed accurately and truthfully.  I have been given ample opportunity to read this document and I understand and agree to all of its terms and conditions.  I understand that I am giving up substantial rights (including my right to sue), and acknowledge that I am signing this document freely and voluntarily, and intend by my signature to provide a complete and unconditional release of all liability to the greatest extent allowed by law.

My signature on this document is intended to bind not only myself but also my successors, heirs, representatives, administrators, and assigns.