Agreement for Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment
You can click on the title to view and/or print a copy of this agreement
Description of Activity: | Adventures in Lifelong Learning activities, including but not limited to: daytrips, classes, lectures, and social events |
Date / Location: | July 1-June 30, 2026 |
I desire to participate voluntarily in the above-described activity at the University of Wisconsin–Parkside.
I UNDERSTAND THAT I AM BEING ASKED TO READ EACH OF THE FOLLOWING PARAGRAPHS CAREFULLY. I UNDERSTAND THAT IF I WISH TO DISCUSS ANY OF THE TERMS CONTAINED IN THIS AGREEMENT, I MAY CONTACT THE ABOVE-NAMED UW-PARKSIDE REPRESENTATIVE.
Assumption of Risk:
I understand that not all risks can be foreseen and there are some risks which are unpredictable. I understand that certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. I am aware of the risks of participation, which include, but are not limited to, the possibility of physical injury, fatigue, bruises, contusions, broken bones, concussion, paralysis, and even death. I understand that I have been advised to have health and accident insurance in effect and that no such coverage is provided for me by the University or the State of Wisconsin. I know, understand, and appreciate the risks that are inherent in this program and activity. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.
Hold Harmless, Indemnity and Release:
In consideration of permission for me to freely and voluntarily participate in the above-described activity, today and on all future dates, I, for myself, my heirs, personal representatives or assigns, agree to defend, hold harmless, indemnify and release the Board of Regents of the University of Wisconsin System, the University of Wisconsin–Parkside, and their officers, employees, agents, and volunteers, from and against any and all claims, demands, actions, or causes of action of any sort on account of damage to personal property, or personal injury, or death which may result from my participation in the above-listed program. This release includes claims based on the negligence of the Board of Regents of the University of Wisconsin System, University of Wisconsin–Parkside, and their officers, employees, agents, and volunteers, but expressly does not include claims based on their intentional misconduct or gross negligence. I understand that by agreeing to this clause I am releasing claims and giving up substantial rights, including my right to sue.
Consent for Emergency Treatment:
I authorize the University of Wisconsin–Parkside and its designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I agree to be responsible for all necessary charges incurred by any hospitalization or treatment rendered pursuant to this authorization.
