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* First Name:

* Last Name:

Affiliation:

* Phone:

* Email:

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Gender:

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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

University of Oregon 
PHYSICAL EDUCATION AND RECREATION 
Agreement of Waiver 
 
I hereby agree that I shall indemnify and hold the State of Oregon, State System of Higher Education, the University of Oregon and the PAC-10 harmless from any and all injuries while participating in the PAC 10 Fitness Challenge.  I understand that there are certain physical hazards involved in the above stated program, and I agree to assume the risks thereof.  I also agree that I have been informed as to the availability of student health insurance that may be purchased.  I know that if I wish additional insurance coverage for said program that I have the responsibility for procuring it myself.  
 
I further understand that the Oregon State Board of Higher Education acting by and through the University of Oregon has no ownership, interest or liability responsibility in and over the contracted agency.  I also acknowledge that 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 Challenge is sponsored by and promoted by the  Department of Physical Education and Recreation at the University of Oregon, which  is a member of the Pac-10.  
 
TO THE EXTENT PERMITTED BY LAW, I WARRANT THAT I: 
 
1. Have read the above statements and understand their provisions; 
2. Understand the risks associated with participation in this activity; 
3. Assume full responsibility for the consequences of choosing to participate in this activity; 
4. Knowingly and intentionally release and hold harmless the State of Oregon, State Board of Higher Education the University of Oregon, and their agents, officers and employees from any and all claims, demands, injuries, actions (including third party claims), and damages of any kind and nature whatsoever which arise out of or in connection with participating in this activity, regardless of whether such claims are based upon negligence or other grounds.

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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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