LOS RIOS COMMUNITY COLLEGE DISTRICT AGREEMENT TO PARTICIPATE AND WAIVER/ASSUMPTION OF RISK
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THIS FORM IS REQUIRED FOR ALL STUDENTS, FACULTY, AND STAFF USING THE SACRAMENTO CITY COLLEGE MAKERSPACE

CLASS/ACTIVITY:

GENERAL MAKERSPACE AND ASSOCIATED EQUIPMENT USAGE, WORKSHOPS, TRAININGS, CLASSES, AND ALL ACTIVITIES OFFERED BY SCC FACULTY, STAFF, AND COMMUNITY MEMBERS

This is a release of liability and assumption of risk agreement. Read it carefully and SIGN BELOW. 

Completion of this form is necessary in order to participate in ALL SACRAMENTO CITY COLLEGE MAKERSPACE activities. I understand my decision to use the SACRAMENTO CITY COLLEGE MAKERSPACE in any capacity, workshop, class, or activity is optional and voluntary.

This document cannot be altered or modified by any verbal or written statements.

PLEASE READ:

I am aware that participating in this Los Rios Community College District (DISTRICT) class or activity (including labs and/or activities undertaken at home or off-campus for online courses) can involve MANY RISKS OF INJURY including, but not limited to, property damage, bodily injury, personal injury and death.

In consideration of the DISTRICT permitting me to participate in any and all activities at the SACRAMENTO CITY COLLEGE MAKERSPACE, I hereby voluntarily assume all risks associated with my participation and release the DISTRICT, its employees and volunteers, its colleges, campuses and centers, its governing board and the individual members thereof, and all other DISTRICT officers, agents and employees from all liability (whether based on negligence or otherwise) for injuries (including death) and damages arising out of or in any way related to the activity and/or class.

I understand that if this is/involves an excursion or field trip as defined by California Code of Regulations, Section 55220 that Section states in part:

“All persons making the field trip or excursion shall be deemed to have waived all claims against the District or the State of California for injury, accident, illness, or death occurring during or by reason of the field trip or excursion. All adults taking out-of-state field trips or excursions and all parents or guardians of minor students taking out-of- state field trips or excursions shall sign a statement waiving such claims.”

By signing this Agreement, I hereby waive all such claims.

I understand and agree to accept all the rules and requirements of the activity and/or class, including safety rules and instructions given by the supervisory personnel. I understand, and agree, and grant to the DISTRICT the right to terminate my participation in the activity and/or class within the DISTRICT’s or DISTRICT’s employee’s sole discretion. If applicable, I understand and agree that any costs associated with my return transportation shall be at my personal expense.

I consent to the DISTRICT providing emergency health assistance if it is determined necessary and further consent to the DISTRICT notifying the emergency contact (listed below) and agree that this liability release and assumption of risk agreement applies to any of the DISTRICT’s actions in this regard.

This agreement shall inure to the benefit of and be binding upon my heirs, decedents, successors, executors, assignees, legal representatives, and all family members. The provisions of this agreement including, but not limited to, my waiver of liability and my assumption of risk shall survive this agreement.

FULL LEGAL NAME: *
LOS RIOS ID NUMBER: (W+7 NUMBERS) *
LOS RIOS EMAIL *
MY PHONE NUMBER (WITH AREA CODE):

The following person(s) should be contacted in case of an emergency

EMERGENCY CONTACT NAME (FIRST, LAST):

 *

EMERGENCY CONTACT PHONE (WITH AREA CODE):

 *

EMERGENCY CONTACT ADDRESS (WITH CITY, STATE, ZIP):

 *
ACKNOWLEDGEMENT OF THIS AGREEMENT

I/WE, THE UNDERSIGNED, HAVE READ THIS AGREEMENT AND UNDERSTAND THAT IT IS A RELEASE OF ALL CLAIMS AND THAT I/WE ARE VOLUNTARILY ASSUMING ALL RISKS AND WAIVING ANY AND ALL CLAIMS ARISING OUT OF OR IN ANY WAY RELATED TO THIS ACTIVITY AND/OR CLASS. I/WE AGREE THAT NO ORAL REPRESENTATIONS, PROMISES, OR INDUCEMENTS, NOT EXPRESSLY CONTAINED HEREIN HAVE BEEN MADE AND THAT THIS DOCUMENT CONSTITUTES THE ENTIRE AGREEMENT PERTAINING TO THE SUBJECT MATTER CONTAINED HEREIN.

I HAVE ALSO READ AND FULLY UNDERSTAND THE MAKERSPACE POLICIES AND PROCEDURES DOCUMENT AND AGREE TO THESE CONDITIONS. I UNDERSTAND THAT FOR FULL ACCESS TO THE MAKERSPACE, I MUST POSSESS A LOS RIOS ID AND BE ENROLLED IN A CURRENT "MAKR" OR "CNC" COURSE SPECIFICALLY, OR FOR LIMITED MAKERSPACE USE, IN ANY CURRENT COURSE OFFERED BY THE LOS RIOS COMMUNITY COLLEGE DISTRICT, WHICH WILL ENABLE MY ABILITY TO LOG IN AND OUT OF THE MAKERSPACE.

BY TYPING YOUR NAME BELOW YOU ARE DIGITALLY SIGNING THIS AGREEMENT *
If participant is under 18, parent or guardian must sign below by typing their name, and providing a phone number for verbal verification.

I acknowledge that I have read and agree to the terms of this agreement.

 *
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A copy of your responses will be emailed to the address you provided.
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