Important: Sign the waiver below!

Please sign the waiver below and give it to Ms. Wilkinson at arrival.

Thanks!

School: ________________________________
City: ___________________________________________ 
Date of Field Trip: ____________________________
Participant’s Name(s) ____________________ __________________ __________________ (Please list all participants including students, adult chaperones and siblings if attending)

UNIVERSITY OF CALIFORNIA
DIVISION OF AGRICULTURE & NATURAL RESOURCES
NAME OF FACILITY/CLASS/ACTIVITY: Elkus Ranch Environmental Education Center Waiver of Liability, Assumption of Risk, and Indemnity Agreement
Wavier: In consideration of being permitted to participate in any way in an
Environmental Education Program, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue The Regents of the University of California, its officers, employees, and agents from liability from any and all claims including the negligence of The Regents of the University of California, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in an Environmental Education Program.
Assumption of Risks: Participation in an Environmental Education Program carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as scratches, bruises, and sprains; 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions; 3) catastrophic injuries including paralysis and death.
I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in an Environmental Education Program. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.
Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD The Regents of the University of California HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement in an Environmental Education Program and to reimburse them for any such expenses incurred.
Severability: The undersigned further expressly agrees that the foregoing waiver and assumption of risks agreement is intended to be broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Acknowledgment of Understanding: I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
_____________________________________ _________________________ 

Signature of Parent or Guardian of Minor and/or Adult Participant Date



Signature of Participant and Date


Participant’s Age (if a minor) __________