Apr 08

Sports and Recreation Liability Waiver

To download free Liability waiver form in PDF, please click Sports and Recreation Liability Waiver

In consideration of becoming a member or being allowed to participate in the activities and programs of WPI’s Sports and
Recreation Center (hereafter Sports and Recreation Center) and to use its facilities and equipment, I do hereby for myself,
my heirs, executors and administrators, waive, release, and forever discharge Worcester Polytechnic Institute (hereafter
WPI), its’ employees and agents, from any causes of action, claims, liabilities or demands of any nature whatsoever, including
but not limited to a claim of negligence, for personal injury, bodily injury, property damage, death or accident of any
kind, arising out of or in any way relating to my participation in activities or programs, and/or use of equipment or facilities
in the Sports and Recreation Center, whether by the negligence of WPI or otherwise. I further agree not to sue, and agree
to indemnify and hold harmless WPI from any and all causes of action, claims, demands, losses or costs, including attorneys’
fees, of any nature whatsoever arising out of or in any way relating to my participation in activities or programs, and/
or use of equipment or facilities in the Sports and Recreation Center. (Please initial ________ )
I understand and am aware that strength, flexibility and aerobic exercises, including the use of exercise equipment and any
Sports and Recreation Center facility, are potentially hazardous activities. I also understand that physical fitness activities
involve a risk up to and including death and that I am voluntarily participating in these activities and using equipment and
facilities with knowledge of the dangers involved. I do hereby declare that I do not pose a significant risk to my or others’
health and safety in my pursuit of physical activity in the Sports and Recreation Center, including use of equipment and/
or facilities and/or participation in activities or programs. I acknowledge that I have either had a physical examination
and have been given my physician’s permission to participate or that I have decided to participate in activity and/or use
of equipment and facilities without the approval of my physician; in either case, I do hereby voluntarily assume all risks and
responsibility for my participation in activities and utilization of equipment and facilities. I agree to limit my participation to
reflect my personal fitness level. I hereby agree to expressly assume and accept any and all risk of injury and/or death. I
further agree that if I do not act in accordance with this agreement and with the rules and regulations governing usage of
the Sports and Recreation Center I may not be permitted to continue to use the facilities or participate in any activities or
programs. (Please initial______ )
I hereby consent to and permit emergency treatment in the event of illness or injury while using the equipment or facilities
and/or while participating in the activities and programs of the Sports and Recreation Center facilities. (Please initial
_________ )
My signature below indicates that I have read, understood, and freely signed this agreement. I further certify that I am
at least eighteen years of age, or, if under eighteen years of age, my parent or legal guardian has signed on my behalf,
and that I am otherwise legally competent to sign this agreement. I further understand that the terms of this agreement are
legally binding. This agreement shall be construed and enforced in accordance with the laws of the Commonwealth of Massachusetts,
and I consent to the jurisdiction of said state. If any portion of this agreement is held invalid, it is agreed that the
balance shall continue in full legal force and effect. (Please initial _______ )
I have read and understand the above provisions and agree to be bound by them, as indicated by
my signature below.
___________________________________ _______________________________________________
Signature Parent or Guardian Signature (if participant under 18)
Print Name_____________________________ Print Name_________________________________________
Date_________________________________ Date ____________________________________________
I will be at WPI during the following dates _______________________________________________________
NOTE: All Sports and Recreation Center users must read and sign this form. Individuals under 18 must also have a legal guardian read and sign. Children under 14 years of age
are not eligible to utilize the facilities other than for special events or programs.

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