In consideration of being allowed to participate in the Recreation & Intramural Programs of ��ߺ��’s (“��ߺ��”), including but not limited to use of the ��ߺ�� Fitness Center/Gymnasium (“Activity”), I acknowledge and agree as follows:

I understand that my participation in the Activity program involves strenuous physical activity and therefore includes inherent risks. The specific risks vary from activity to activity, but the risks include 1) minor injuries such as scratches, bruises, contusions, and muscle strains and sprains, 2) major injuries such as broken bones, muscle injuries, torn ligaments, loss of teeth, eye injuries or loss of sight, joint or back injuries, heart attacks, and concussions; and 3) catastrophic injuries including paralysis and death. I understand that there may be other risks not known or reasonably foreseeable.

I VOLUNTARILY ACCEPT AND ASSUME ALL OF THE RISKS IN PARTICIPATING IN THE ACTIVITY.

I understand that ��ߺ�� strongly advises students, faculty, staff, and alumni to have medical check-ups before engaging in physical activity. I am not aware of any physical or health condition that would prevent me from safely participating in the Activity.

I understand that ��ߺ�� does not maintain any health and/or accident insurance or workers compensation plan covering my participation in the Activity. As such, I am aware that it is recommended that I have my own personal health insurance.

I, for myself and on behalf of my family, heirs and personal representative(s), HEREBY RELEASE AND HOLD HARMLESS ��ߺ��, The City University of New York, the City of New York, the State of New York, and the officers, directors, employees, representatives, agents or affiliates of any and all of them (“Released Parties”) FROM ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, ACTIONS AND CAUSES OF ACTION WHATSOEVER arising out of or related to any loss, damage, or injury (including death) to me or others, or to any property belonging to me or others, caused by, deriving from, or associated with my participation in, or travel to or from the Activity, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASED PARTIES OR OTHERS, except for such damages or injury as may be caused by the gross negligence or willful misconduct of the officers, directors, employees, representatives, agents or affiliates of any of them.

I hereby agree that this Release be construed in accordance with the laws of the State of New York. I agree that this Release, including any parental consent, will be binding to the fullest extent permitted by law. If any provision of this Release, is held to be invalid, that provision will be limited only to the minimum extent necessary to comply with applicable law, and the validity of the remaining provisions will not be in any way affected. I HAVE READ ALL OF THIS RELEASE AND I FULLY UNDERSTAND IT. I AM VOLUNTARILY SIGNING THIS RELEASE WITH THE INTENTION TO BE BOUND BY ITS TERMS. NO REPRESENTATIONS, STATEMENTS, OR INDUCEMENTS NOT CONTAINED IN THIS RELEASE HAVE BEEN MADE TO ME BY ANY OF THE RELEASED PARTIES.

If you are less than 18 years old, a parent or guardian must sign an additional consent form. (see age box below)

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Consent and Release Form

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