Statement of Personal Responsibility
I, the undersigned, who is at least 18 years of age, desire to participate
in the Stanford _________________________ program, and do hereby declare
that I have read, understood and accepted the following:
The following activity ______________________________ necessarily
exposes participants to risk. There exist inherent safety hazards in
the physical activities undertaken by all Stanford students and instructors.
I am aware of and accept these risks and dangers to life and limb as
an unavoidable part of my voluntary participation in Stanford program
called _____________________________ .
I am at all times responsible for my own safety when I participate
in any Stanford activity or outing.
I hereby waive, for myself and for anyone else claiming through me,
any and all rights and claims of any nature that I may have against
Stanford University, the Office of Student Activities, ____________________________
, and any of its participants, for and against any and all injuries
or damages of any nature, including death, while voluntarily taking
part in a Stanford event.
I agree to pay any reasonable cost to repair or replace any Stanford
equipment lost or damaged by myself or through my actions, whether by
accident or negligence. The determination of whether to replace or repair
damaged equipment shall be made by the Stanford __________________________
instructors/sponsors. I will not be responsible for normal wear and
tear on Stanford equipment.
SAFETY IS THE PRIMARY CONCERN OF THE STANFORD ____________________________
PROGRAM. IN SIGNING THIS WAIVER, I ACKNOWLEDGE THAT I AM AT LEAST 18
YEARS OF AGE AND THAT I CHOOSE TO PARTICIPATE SOLELY AT MY OWN RISK.
(Name of participant)
(Signature of parent or legal guardian if participant is under 18)