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WAIVER, RELEASE AND INDEMNITY AGREEMENT
ASSUMPTION OF RISK FOR PARTICIPATION
IN VOLUNTARY NONDISTRICT SPONSORED ACTIVITY
Adult Employee/Volunteer: ________________________________________________________________
Description of Activity: ____________________________________________________________________
Date(s) of Activity: ________________________________________________________________________
By my signature below, I hereby agree to participate in the above described activity. I realize that this activity is voluntary
and is not part of the Los Gatos Union (District) program.
The undersigned hereby acknowledges that he/she knowingly and voluntarily assumes all risks of bodily injury and
expressly acknowledges their intention, by executing this instrument, to exempt and relieve the District, its officers, agents,
and employees, from any liability for personal injury, bodily injury, property damage or wrongful death that may arise out
of or in any way be connected with the above described activity.
As a condition of my participation in this activity, I agree to waive all claims against the Los Gatos Union (District) and to
indemnify and hold the District, its officers, agents, and employees, harmless from any and all liability or claims,
demands, losses, causes of action, suits or judgments of any kind whatsoever that I, my heirs, executors, administrators or
assignees may have against the District or that any other person or entity may have against the District because of any
death, bodily injury, personal injury, or illness, or because of any loss to property that may arise out of or in any way be
connected with the above described activity.
The undersigned fully acknowledges that no District employees or designated volunteers will be participating in
their capacity as District employees or designated volunteers, and that the District assumes no responsibility for any
transportation arrangements. I further acknowledge that there is no District insurance coverage provided of any
type, including but not limited to, workers’ compensation, liability, collision, comprehensive or medical coverage in
connection with the above described activity. I have read the foregoing and have voluntarily signed this agreement.
I am aware of the potential risks involved in this activity and I am fully aware of the legal consequences of signing
this instrument.
________________________________________________ __________________________________________
Adult Employee/Volunteer Signature Date
________________________________________________
Street Address
________________________________________________
City State Zip Code
( )________________________________________
Telephone Number