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* First Name:

* Last Name:

Affiliation:

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* 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

UNIVERSITY OF WASHINGTON 
DEPARTMENT OF RECREATIONAL SPORTS PROGRAMS 
 
PAC-10 FITNESS CHALLENGE  
ASSUMPTION OF RISK AND RELEASE AGREEMENT 
 
In consideration for my participation in the Pac-10 Fitness Challenge held October 27-31, 2008, I acknowledge that participating in physical activities involves inherent hazards and risks of serious personal injuries such as, but not limited to:  paralysis, brain damage, loss of vision or limb function, permanent scarring, disability and/or death, and I assume all such risks.  I represent that I am physically capable of participating in physical activities.  I realize that the inherent risks of participating in an exercise program may include injuries due to equipment failure, bad decision-making, and my underlying physical and mental condition.  I understand that freak accidents occur and I assume all risks associated with such accidents, even though I cannot foresee them. 
 
In further consideration for being allowed to participate in the Pac-10 Fitness Challenge and associated activities, I hereby release and hold harmless the Pacific-10 (Pac-10) Conference, University of Washington and its Regents, Recreational Sports Programs, and all of their respective officers, employees, agents and representatives from any and all liability, for personal injury, or property damage or loss arising from my participation in the Pac-10 Fitness Challenge, whether such loss results from my own negligence or that of other participants, or any other cause. 
 
I HAVE READ THIS DOCUMENT, UNDERSTAND IT TO BE A BINDING CONTRACT, AND SIGN IT OF MY OWN FREE WILL.

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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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