Rev. 06/2020
WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT
Hereinafter called the “Activity”, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive,
discharge, and covenant not to sue the Chaffey Community College District, its officers, employees, and agents from
liability from any and all claims including the negligence of the Chaffey Community College District, 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 the High School Partnership/Dual Enrollment Program (the Activity).
Assumption of Risks: Participation in the Activity 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 to 3) catastrophic injuries including paralysis and death.
Indemnification and Hold Harmless: I also agree to INDEMNIFY AND HOLD CHAFFEY COMMUNITY COLLEGE
DISTRICT 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 the Activity 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 as broad and inclusive as is permitted by the law of the State of California including Education Code
Section 72640 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 all previous paragraphs, including the waiver of liability, assumption
of risk, and indemnity agreement, know, fully understand its terms, acknowledge these and other risks that are inherent
to the Activity, and understand that I am giving up substantial rights, including my right to sue. I acknowledge
my participation is voluntary, that I knowingly assume all such risks, ant 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 extent
allowed by law.
In the event of any illness or injury, I give full authority to the district staff to obtain such medical treatment and/or
surgery from a licensed physician/surgeon, paramedic or hospital as deemed necessary for the welfare of my child. I
acknowledge that I fully and completely understand the potential risks that may be associated with this Activity and that
my child’s participation is strictly voluntary.
Additional Information - Supervision of Minors: Chaffey College assumes no responsibility for the supervision of
minor students outside the classroom setting. Parents are responsible for providing transportation and ensuring their
children are supervised before and after class, and if or when a class is cancelled or dismissed earlier than the
scheduled time. Chaffey College will not call the parent/guardian if a student is absent, nor will we verify attendance.
Course Content – College is an adult environment with minimal supervision. Discussion topics and course materials
are generally designed for adult students and may not be appropriate for younger students. Course content will not be
altered to accommodate younger students.
Internet Usage - Many courses required computer lab work or research projects that could involve the Internet.
Chaffey’s computer network provides access to the Internet in classrooms, labs, and the library. The College does not
block access to specific Internet sites. As a result, it is possible for your son/daughter to reach an Internet site that you
may feel contains inappropriate material.
My signature below accepts the terms and acknowledges the information outlined above. My son/daughter has
my approval to enroll in Chaffey College courses.
___________________________________________________________ ____________________________
Student Signature Date Participant’s Date of Birth (m/d/yy)
___________________________________________________________ (______)_____________________
Signature of Parent/Legal Guardian Date Day Phone
___________________________________________________________ (______)_____________________
Print Parent/Legal Guardian Name Night Phone
____________________________________________________________________________________
Name of Health Insurance Company Policy/Group Number
Medical Problems (check one) ____ None ____Yes, Please Explain _____________________________________
Emergency Contact: In the event of accident or sudden illness, Chaffey College will attempt to contact the parents
at the phone number(s) listed above. Please list a designated contact in case we are unable to reach you.
_______________________________________________________ (______)_____________________
Name Relationship Phone
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