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* First Name:

* Last Name:

Affiliation:

* Phone:

* Email:

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Group Affiliation:

Group Name:

(Name of student organization, residence hall,
fraternity/sorority if applicable)

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You must be 18 years of age by October 26, 2009 to participate in the Pac-10 Challenge warm-up.

* Birthdate (MM/DD/YYYY):

RELEASE/DISCLAIMER

In consideration of being permitted to participate in the Pac-10 Fitness Challenge, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue the Pacific-10 Conference, its directors, officers, employees, and agents from liability from any and all claims, resulting in personal injury, accidents or illnesses (including death), and property loss arising from my participation in the Pac-10 Fitness Challenge.

I also agree to indemnify and hold the Pacific-10 Conference harmless from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney fees brought as a result of my involvement in the Pac-10 Fitness Challenge and to reimburse them for any such expenses incurred.

I also acknowledges that the Pac-10 Fitness Challenge is not a Pac-10 varsity sport nor is it sponsored by or organized by the Pacific-10 Conference.

Assumption of Risk, Release of Liability

Read this Acknowledgement of Risk and Waiver of Liability carefully and in its entirety.  It is a binding legal document.  

I, the undersigned, am aware that participation in the PAC-10 Fitness Challenge 2008 (hereafter referred to as the Challenge) may include actions and events that are risky and dangerous.  I acknowledge that participation in this activity has the following non-exhaustive list of particular activities that bear risk and danger and from which bodily injury, up to and including mortal injury, may occur:  

Fitness Walk, Informational Tables and Booths, Fitness Activities, Fitness Instruction and Table Tennis

With full knowledge of the facts and circumstances surrounding the activity described above, I voluntarily participate in the activity and assume all responsibility for and risk resulting from, my participation, including all risk of property damage and injury to others and to myself. I agree to comply with all of the rules and conditions of participating in the Activity. I have adequate health insurance necessary to provide for and pay any medical costs that may directly or indirectly result from my participation in the Activity.  I will indemnify and hold the Pac-10 (hereafter referred to as Pac-10) and the State of Oregon, acting by and through the State Board of Higher Education, on behalf of Oregon State University, it employees, directors, officers, and agents (hereafter referred to as University) harmless with respect to any and all claims, injuries, and costs associated with participation in this activity.  In addition, I acknowledge that the Challenge is not a Pac-10 varsity sports event and the Pac-10 is not a sponsor or organizer of the said event.

I am aware that if I provide a vehicle not owned and operated by the University for transportation to, at, or from the activity, or if I am a passenger in such a vehicle, the University is not responsible for any damage caused by or arising from my use of such transportation.  I understand that I will be expected to accept full responsibility and liability for myself and my passengers and that I have automobile liability insurance in accordance with Oregon Insurance Requirements or the state in which my vehicle is licensed.

Furthermore, I acknowledge that I am solely responsible for any action that I participate in associated with this activity or around this activity, regardless if occurring before, during or after the period of the activity.  I will conduct myself in a manner that is considerate of other participants and in accordance with University Rules and Regulations (including Student Code of Conduct) and with any state and city laws or rules where the activity is occurring.  

To the extent permitted by law, and in consideration for being allowed to participate in the activity, I hereby save, hold harmless, discharge and release the Pac-10 and the University from any and all liability, claims, causes of actions, damages or demands of any kind and nature whatsoever that may arise from or in connection with my participation in any activities related to the activity, whether caused by the negligence or carelessness of the Pac-10 or the University or otherwise.

It is my express intent that this Acknowledgement of Risk and Waiver of Liability shall bind my spouse, the members of my family and my estate, heirs, administrators, personal representatives and assigns.  I further agree to save, hold harmless and indemnify the Pac-10 and the University from any claim by the aforementioned parties arising out of my participation in the activity.

I recognize and acknowledge that the Pac-10 and the University makes no guarantees, warranties, representations, or other promises relative to the activity, and assumes no liability or responsibility for injury or property damage that I may sustain as a result of participation in the activity.  I recognize and acknowledge that I am not representing an agent or employee of the Pac-10 or the University, that I may not and will not represent myself as such, and that I cannot and will not bind or obligate the University in any way.  I further recognize and acknowledge that I am not entitled to make claims under workers' compensation laws as a result of my participation in the activity.  I further understand and agree that this Release is intended to be as broad and inclusive as permitted by law. If any portion hereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full force and legal effect.  

I hereby certify that, with or without accommodation,* I have no health-related reasons or problems that preclude or restrict my participation in the Activity.  I hereby consent to first aid, emergency medical care, and, if necessary, admission to a hospital for such care or treatment for injuries that I may sustain while participating in any events associated with the Activity.

In signing this Acknowledgement of Risk and Waiver of Liability I hereby acknowledge and represent:  (a) that I have read this Acknowledgement of Risk and Waiver of Liability in its entirety, understand it, and sign it voluntarily; (b) that I am of legal age; and (c) that this Acknowledgement of Risk and Waiver of Liability is the entire agreement between the parties hereto and its terms are contractual and not a mere recital.

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The registration information collected will be used solely for the Pac-10 Fitness Challenge. Your personal information (name, address, email, date of birth, phone number) will never be given or sold to a third party. You will only be contacted for Pac-10 Fitness Challenge specific purposes, such as winning an incentive prize or to provide updates.

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