HCI Group Classes Liability Waiver

IMPORTANT: THIS IS A LEGAL DOCUMENT. PLEASE READ AND UNDERSTAND THIS DOCUMENT BEFORE SIGNING. ASSUMPTION OF RISK, WAIVER OF LIABILITY, AND INDEMNIFICATION AGREEMENT This agreement must be completed to participate in the activities associated with this program and course. Program/Course: Huntsman Cancer Institute Linda B. and Robert B. Wiggins Wellness and Integrative Health Center, P.O.W.E.R Program, Community Programs Date of Program: (good only one year from this date) I, the undersigned, am either the Participant named above or the parent and/or legal guardian (“Guardian/Parent”) of the minor Participant named above. I am familiar with the curriculum and the activities which take place in the above named course. TERMS AND CONDITIONS I will participate or authorize the Participant to participate in the above program and course at the University of Utah (the “Program”). I understand that such participation can include foreseeable and unforeseeable risks and other hazardous activities inherent in the program which may expose the participant to illness, injury, or death. Participant or guardian/parent freely and voluntarily participates or allows participation in the program with the knowledge of the danger involved and hereby agrees to assume and accept any and all risk of injury or death. Note: There is a potential risk of precipitating or exacerbating Lymphedema with repetitive arm movements although this risk is unclear. Some groups (e.g., National Lymphedema Network); recommend the use of a compression garment for strenuous activity, but the value of this intervention is not clear. Gradual and sustained weight training and stretching are recommended. This risk of Lymphedema is present during hiking, snowshoeing, biking, fly-fishing, rowing, indoor group fitness and aquatoning. Hiking/Snowshoeing: I understand that as with any physical activity there is risk of musculoskeletal injuries, cardiovascular event. Due to being outdoors there is also risk of dehydration, heat illness, sunburn, frostbite, and other injuries related to hiking. Guides will only be available to support hikers who stay with the group throughout the duration of the organized hike. Biking: I understand that there is risk of falls, musculoskeletal injuries, overuse injuries, sunburn, cardiovascular event, head injuries, dehydration as well as other unforeseen injuries due to biking. Guides will only be available to support bikers who stay with the group throughout the duration of the organized bike ride. Fly Fishing: I understand some risks, but not all, include: sunburn, insect bites (and any side effects), hypothermia, musculoskeletal injuries, drowning, fishing hook injuries, and injuries from repetitive arm movements. Rowing: I understand some risks, but not all, include: sunburn, hypothermia, musculoskeletal injuries, drowning, and injuries from repetitive arm movements. Aquatoning: I understand some risks, but not all, include: skin irritations from chlorine, musculoskeletal overuse injuries, drowning, and injuries from repetitive arm movements. Indoor Group Fitness: I understand some risks, but not all, include: musculoskeletal injuries, dehydration, lightheadedness, dizziness, and injuries from repetitive arm movements or equipment malfunctions.

WAIVER, RELEASE, AND INDEMNIFICATION

Participant or Guardian/Parent of Participant understands and acknowledge that the University of Utah (“University”) is not an insurer of Participant’s behavior, actions or participation in the program, and that the University assumes no liability whatsoever for personal injuries or property damages to Participant or to third persons arising out of Participation in the Program activities. Participant or Guardian/Parent hereby agrees to release, waive, covenant not to sue, indemnify and hold harmless the University, and all of their officers, employees and agents (collectively the “Releases”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by Participant or loss or damage to any property belonging to Participant arising out of or related to participation in the above named Program, and excepting only such loss, damage or injury as may be caused by the sole negligence of any Releases. Participant of Guardian/Parent of Participant agrees that the site of any lawsuit arising out of or related to participation in the Program shall be Utah and that this Agreement will be governed by and construed in accordance with the laws of the state of Utah, without application of any principles of choice of law. Participant does not have any medical conditions that would prevent participation in Program activity. PARTICIPANT IS CLEARED BY THIER PHYSICIAN FOR EXERCISE ACTIVITIES. Participant has adequate health insurance to cover the costs of treatment in the event of any injury. Participant shall pay any attorney fees or costs incurred by the University in enforcing this Agreement. If any portion of this Agreement is held to be invalid by a court of law, then it is agreed and intended that all the remainder shall, notwithstanding, continue in full force and effect. PARTICIPANT OR GUARDIAN/PARENT OF PARTICIPANT HAS CAREFULLY READ THESE TERMS AND FULLY UNDERSTANDS THEIR CONTENT AND IS AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN PARTICIPANT OR GUARDIAN/PARENT OF PARTICIPANT AND THE RELEASEES AND SIGNS IT OF HIS OR HER OWN FREE WILL.

By Checking this box, I acknowledge that I am eighteen (18) years of age and that I understand the terms of this Agreement. I also acknowledge this Agreement shall bind my heirs and personal representatives.*

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