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* First Name:

* Last Name:

Affiliation:

* Phone:

* Email:

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University ID:

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

The University of Arizona 
Department of Campus Recreation Fitness Program - Pac-10 Fitness Challenge 
ASSUMPTION OF RISKS AND PERSONAL RESPONSIBILITY 
In consideration of the services of the University of Arizona Fitness Program, The State of Arizona, The Arizona Board of Regents, The University of Arizona, the Department of Campus Recreation, their officers, agents, employees and all other persons or entities associated with it (the Fitness Program), I agree as follows: 
 
Although the Fitness Program has taken reasonable steps to provide me with an appropriate environment and staff supervision so I can enjoy this activity for which I may not be skilled, I acknowledge that this activity is not without risk.  Certain risks cannot be eliminated without destroying the unique character of this activity.  The same elements that contribute to the unique character of this activity can be causes of loss or damage to my equipment, accidental injury, illness, or extreme cases, permanent trauma or death.  I understand that even though precautions have been taken by the Fitness Program to provide safe workout conditions, I am responsible for my health and safety at all times.  I understand that if I am participating in a Fitness Program activity, I may modify or discontinue my workout at any time if I experience pain or discomfort, and I agree to take responsibility for my safety when working out in varying environments, including those times when I am working out outside, on campus and off campus, or within a Department of Campus Recreation facility, regardless whether I am under the supervision of Fitness Program staff.  Risks include, but are not limited to sprains, strains, breaks, concussions, cuts, loss of eyesight, cardiac arrest, partial or total paralysis and death, plus injuries caused by uneven footing in outdoor areas, dehydration or heat exhaustion, and life-threatening injuries sustained from impact by cars, bikes, or other vehicles. 
 
I am aware that fitness activities include risks of injury or death to myself.  I understand that the description of these risks is not complete and that other unknown or unanticipated risks may result in property loss, injury or death.  I agree to assume responsibility for the inherent risks identified herein and those inherent risks not specifically identified.  I understand that my participation in this activity is purely voluntary, and that no one is forcing me to participate, and I elect to participate in spite of and with full knowledge of the inherent risks. 
 
I am aware that fitness activities may require a high level of physical exertion.  I have verified with my physician or other medical professionals that I have no past or current physical or psychological condition that might affect my participation in this activity. 
 
I understand that this Assumption of Risks and Personal Responsibility statement is governed by the laws of the State of Arizona. 
 
I certify that I am fully capable of participating in this activity, without causing harm to myself or others.  Therefore, I, and my parent(s) or guardian if I am a minor, assume full responsibility for me and for bodily injury, death and loss of personal property and expenses suffered by me and them as a result of those inherent risks and dangers identified herein and those inherent risks and dangers not specifically identified, and as a result of my negligence in participating in this activity. I shall hold The University of Arizona and the Pac-10 harmless and relieve The University of Arizona and the Pac-10 from any potential liability due to my participation in the Pac-10 Fitness Challenge. I also acknowledge the Pac-10 Fitness Challenge is not a Pac-10 varsity sports event, and the Pac-10 is not a sponsor or organizer of said event. I acknowledge that the Pac-10 Fitness Challenge is sponsored by and promoted by The University of Arizona, a member of the Pac-10. 
 
I, and my parent(s) or guardian if I am a minor, have read, understood and accepted the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon myself, my heirs, assigns, personal representative and estate and all members of my family.

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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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