This Assumption of Risk, Waiver, and Release of Liability is a legal agreement executed in favor of the University of Chicago, University of Chicago Medical Center, its affiliated organizations, trustees, directors, offices, employees and agents. Please read this document carefully before signing.

I, _______________________________, acknowledge that I freely and voluntarily have agreed to allow my minor child/ward, _________________________________ (“Minor”) to participate in a program (“Program”) facilitated or organized by the University of Chicago ( “School”).

1. General Waiver and Release of Liability
   I understand that the Minor’s participation in the Program may involve risks of injury including death. I hereby release, waive and discharge the School, its affiliates, and their respective trustees, officers, agents and employees from any and all liability, claim, damages and losses arising out of or in connection with the Program, including, without limitation, any loss, damage or injury or death or other circumstances beyond the control of the School, that may be sustained by the Minor or to any property belonging to the Minor while participating in the Program.

   Medical Treatment
   I understand that the School does not provide health insurance for the Minor. I therefore certify that I or my insurance (including any supplemental health insurance I may elect to purchase as part of the Program) will be responsible for the costs of medical services that might be necessary due to accidents, illnesses or injuries the Minor may face while participating in the Program.

2. Assumption of Risk
   I recognize that there may be unavoidable and unforeseeable risks involved in the Minor’s participation in any program. I further agree that the Minor’s participation in any activity will be at my or the Minor’s own discretion and judgment. I voluntarily assume the risk of injury or harm to the Minor or the Minor’s property during his/her participation in this Program. I understand that the University of Chicago is not responsible for the acts or omissions of any third party.

3. Knowledge of Risks
   I accept responsibility for informing myself of the potential risks associated with the activities involving in the Program.

It is my express intent that this Acceptance of Risk Agreement shall bind the members of my family, my heirs and assigns. This agreement shall be construed in accordance with the laws of the State of Illinois.

I have read and fully understand the above Acceptance of Risk, Waiver and Release of Liability Agreement.

Parent or Guardian(Please print):______________________________________________________

Signature______________________________________________ Date_________________