Associated Students, Inc. 2012-13 RELEASE OF LIABILITY, PROMISE NOT TO SUE.

Activity and Date(s) and Time(s): CSUEB Orienation VIP Visits to the RAW Date: June 27, 2013 - August 9, 2013 Activity Location(s),

Premises or Facility(ies): Recreation and Wellness Center, Fitness Center

In consideration for being allowed to participate in this Activities and/or use of the Premises or Facility, on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue the State of California, the Trustees of the California State University, California State University, East Bay, and their employees, officers, directors, volunteers and agents (collectively "University") and the Associated Students, Inc. and their employees, officers, directors, volunteers and agents (collectively "Auxiliary Organization") from any and all claims, including claims of the University's or Auxiliary Organization's negligence resulting in any physical or psychological injury (including paralysis and death), illness, property damage or economic or emotional loss I may suffer because of my participation in this Activity, including travel to, from and during the Activity.

I am voluntarily participating in the Activity. I am aware of the risks associated with traveling to, from and participating in the Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, death and/or property damage. I understand that these injuries or outcomes may arise from my own or other's actions, inaction, negligence, conditions related to travel, or the condition of the Activity Location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and during the Activity.

I agree to hold the University and Auxiliary Organization harmless from any and all claims, including attorney's fees or damage to my personal property that may occur as a result of my participation in this Activity, including travel to, from and during the Activity. If I need medical treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.

I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the University and the Auxiliary Organization from all liability, (b) promising not to sue the University and the Auxiliary Organization, (c) and assuming all risks of participating in the Activity, including travel to/from and during the Activity. I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me.

Please select who will be participating...

Adult - Age 18 and over
Minor - Age 17 and under

Date of Event*

  • June 27 & 28

  • August 1 & 2

  • August 8 & 9

Participant Name

  • First Name*
  • Middle Name
  • Last Name*

Participant's Date of Birth*

Participant's Phone*

Participant's NetID*

Emergency Contact

  • First Name*
  • Middle Name
  • Last Name*

Relationship

Contact Phone*

Secondary Emergency Contact

  • First Name*
  • Middle Name
  • Last Name*

Relationship

Contact Phone

Participant's Signature

Sign below by holding down the mouse button.

Electronic Signature Consent*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead of electronic signature and may contact ASI Recreation & Wellness facility at 510-885-4749. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary

Yes, I Agree.*

Email Address

Email*

The signed document will be emailed to you.

Date of Event*

  • June 27 & 28

  • August 1 & 2

  • August 8 & 9

Minor's Name

  • First Name*
  • Middle Name
  • Last Name*

Minor's Date of Birth*

Participant's Phone*

Participant's NetID*

Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.

Parent or Guardian's Name


  • First Name*

  • Middle Name

  • Last Name*

Minor's Parent or Guardian's Signatures

Sign below by holding down the mouse button.

Electronic Signature Consent*

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead of electronic signature and may contact ASI Recreation & Wellness facility at 510-885-4749. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary

Yes, I Agree.*

Emergency Contact


  • First Name*

  • Middle Name

  • Last Name*

Relationship

Contact Phone*

Secondary Emergency Contact


  • First Name*

  • Middle Name

  • Last Name*

Relationship


Contact Phone

Email Address

Email*

The signed document will be emailed to you.