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Kingsborough Community College Physical Education Facility

Name _______________________________

Address _____________________________

City/State/Zip ________________________

Phone Home ( ) __________ Business ( ) ____________

E-mail address ____________________________

Welcome to the Kingsborough Community College (KCC) Physical Education Center! We are pleased to offer KCC alumni use of our beautiful facilities, including a state-of-the-art Fitness Center and Olympic-sized swimming pool.

Agreement to Waive Liability Rights

Voluntary Participation

1. I, ______________________, acknowledge that I am voluntarily using the facilities located at Kingsborough Community College (KCC) and certify that I have recently seen a physician and have been cleared to participate in the activities within the Kingsborough Community College Physical Education facility.

Release of KCC

2. By execution of this release, I expressly agree that Kingsborough Community College, the City University of New York, and their respective agents, employees, and representatives shall not be liable for any damages arising from injury to person or property sustained by me on or about the premises of the Physical Education facility or resulting from use or misuse of the equipment or facilities therein.

I assume full responsibility for any personal injuries or damages or losses to personal property which may occur to me in, on, or about the premises of the Physical Education facility and do, hereby, for myself, my heirs, administrators, successors and assigns, full and forever release and discharge KCC from any and all claims, demands, damages, rights of action or causes of action, now existing or unanticipated, resulting from or arising out of my use, misuse or intended use of the Physical Education facility or the facilities and equipment thereof.

I further agree to protect, indemnify, save and hold harmless KCC against and from all damages, suits loss, claims, liability or expense (including without limitation, court costs, and attorney fees) arising out of, from or in any way relating to my use, misuse or intended use of the KCC Physical Education facilities and the equipment thereof.

Knowing and Voluntary Execution

I have received a copy of the rules and regulations of the KCC Physical Education facilities and agree to abide by such rules now in effect or hereafter in force.

I have carefully read this agreement and full understand its intent.

Name _____________________________

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Signature _______________________________ Date _____________________