Western Oregon University
Division of Health, Physical Education and Athletics
Assumption of Risk Activity Waiver
Participants in the Western Oregon University Wolves Cheerleading Clinic/Camp agree to the following conditions:
· I understand there is a risk of injury in participating in the Wolves Cheerleading Clinic due to the inherent nature of the activity.
· Participation is voluntary and failure to comply with instructions will terminate my son/daughter’s participation.
· My son/daughter must share in the responsibility for his/her personal safety and not endanger others who are participating in this class.
· I acknowledge that my son/daughter has the physical capacity necessary to engage in the Wolves Cheerleading Clinic.
· In case of emergency, accident or illness I give my permission for my son/daughter to be treated by a professional medical person and be admitted to a hospital if necessary.
· The Oregon Tort Claims Act (ORS30.260 to 30.300) permits Western Oregon State University to accept responsibility only for the acts of its officers, employees, and/or agents. Western Oregon University is prohibited from accepting any liability for the acts, omission and conduct of persons participating in activities. I indemnify, defend and hold harmless the State, Western Oregon University, its officers, agents and employees from all claims, suits or actions of any nature arising out of my participation in this class, other than negligent acts of Western Oregon University, its officers, employees or agents.
By signing below I acknowledge that I understand this assumption of risk and agree to the conditions listed above.
Parent’s name (If under 18)_________________________________
Signature_____________________________________ Date__________________
Camper’s name________________________________
Signature (If over 18)________________________________ Date___________________
Telephone/Emergency Contact__________________________
Medical Insurance:
Policy Number_______________________________ Group #___________________
