Safety & Loss Prevention
Risk Awareness Agreement Form
I also voluntarily and without reservation and on behalf of myself, my heirs, and my estate, hereby
indemnify, defend and save harmless the State of Wisconsin, the Board of Regents of the University of
Wisconsin System, and the University of Wisconsin - ______________, their officers, employees, and
agents from any and all liability, loss damages, costs, or expenses which are sustained, incurred, or
required arising out of my actions in the course of the above program.
I further agree to follow all procedures and safety precautions set forth by the program directors or the
University and give them full authority to take whatever action they feel is warranted under the
circumstances regarding my health and safety if I am not in a condition to give informed consent
including but not limited to the application of emergency medical procedures, the admittance to a hospital, or the care of a medical professional at my expense.
As a participant in the __________________________________________ program, I hereby state that
I am aware of and accept the risk inherent in the above program activity.
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Signature of Participant Date
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Signature of Parent if Participant is less than 18 years old. Date
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Signature of Witness Date
Comments
Each individual using the University Facility must sign a Risk Awareness Agreement