Waiver of Emergency Medical Treatment

Waiver of Emergency Medical Treatment

Waiver of Liability and Hold Harmless Agreement

I, the undersigned participant in the above event, acknowledge that I have suffered an injury or illness during said event and have been offered medical assistance and/or transport to a medical facility for said injury. However, I have declined such medical assistance/transport to a medical facility and have willingly elected to continue in the above event with full understanding that my conduct may increase my risk of serious injury or death, including other unknown risks not reasonably foreseeable at this time, and that I willingly agree to assume all risk and accept personal responsibility for my actions and any damages as a result of such injury, including permanent disability or death, and I do hereby release, discharge and covenant to indemnify and not to sue the organizer(s), including but not limited to Union Adventist University, its affiliates, board members, respective officers, directors, employees, agents, successors, assigns, and each of them, of said event, its affiliated organizations and sponsors, employees and associated personnel, officers, directors, agents, including the owners and lessors of premises used to conduct the event, and I also agree to save and hold harmless and indemnify each and all parties herein referred to above from all liability, loss, cost, claim or damage whatsoever as a result of my actions referenced herein.

IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Waiver of Emergency Medical Treatment, understand it, and sign it voluntarily by my own free act and deed; and that I am at least nineteen (19) years of age and fully competent to execute this agreement.

Type your name (First and Last) here.
Use your mouse or finger to draw your signature.
IF PARTICIPANT IS AGE 18 OR YOUNGER *(the age of majority in Nebraska is 19),* type your name (First and Last) here.
Use your mouse or finger to draw your signature.
Made with formesign