Colorado Parks and WildlifeOutdoor Skills/Outreach Programs

ASSUMPTION OF RISK, WAIVER OF LIABILITY, COVENANT NOT TO SUE, AND AGREEMENT TO INDEMNIFY AND HOLD HARMLESS

Event Name: Event Date:Event Location:Landowner Name, if Not CPW:Check Applicable Program Type for Event:

Outdoor Skills Hunter Outreach Angler Outreach Women Afield

I, _______________________________________, in consideration for participation in the outreach program noted (print name)

above with Colorado Parks and Wildlife, do hereby state and agree:

OR

We, ____________________________________the youth participant, and ________________________________ (print name) (print name)

the parent(s) or guardian of the youth participant, in consideration for the youth’s participation in the outreach program noted above with Colorado Parks and Wildlife, do hereby state and agree:

1. _________ I (We) ACKNOWLEDGE that participation in the above noted program involves certain DANGERS, including, but not necessarily limited to, those associated with the discharge of firearms and other hunting, fishing, or outdoor skills activities, the RISKS of WHICH I (we, he, she,) ASSUME, and which include, but are not necessarily limited to, injury or death to me (and/or the youth participant), and/or damage to or loss of my (and/or the youth participant’s) property.

2. ________ I (We) expressly REPRESENT to Colorado Parks and Wildlife that I (we, he, she) have/has NO MEDICAL CONDITION or physical limitation which would adversely affect my(our, his, her) ability to participate in this program; and that I(we, he, she) has/have adequately prepared myself (ourselves, himself, herself) for such activity.

3. ________ I (We) do hereby, RELEASE the State of Colorado, Colorado Parks and Wildlife, and all other departments, agencies, commissions, boards, institutions, officials, employees, agents of the State and participating sponsors, landowners, and volunteers, FROM ANY AND ALL LIABILITY for any and all causes of action which I (we, he, she) may hereafter have/has on account of any and all injuries to my (and/or the youth participant’s) person, including death, and/or damage or loss of my (our, his, her) property arising out of or related in any way to my (and/or the youth’s) participation in this program, whether such injury results from the negligence of the State of Colorado, Colorado Parks and Wildlife, or any other departments, agencies, commissions, boards, institutions, officials, employees, or agents of the State, or participating sponsors, landowners, or volunteers, or from any other cause.

4. _________ I (We) do hereby COVENANT NOT TO SUE the State of Colorado, Colorado Parks and Wildlife, or any other departments, agencies, commissions, boards, institutions, officials, employees, agents of the State, or participating

Updated: 9/14/2016

sponsors, landowners, or volunteers and AGREE TO INDEMNIFY, SAVE AND FOREVER HOLD THEM AND EACH OF THEM HARMLESS from any liability, including court costs and attorney fees incurred in defending any and all claims, demands, actions, or causes of actions against them or each of them arising out of or related in any way to my and/or the youth’s participation in this program.

5. ________ This RELEASE OF LIABILITY AND AGREEMENT TO INDEMNIFY AND HOLD HARMLESS shall be binding upon me(us, and/or the youth participant) and my(our, his, her) heirs, executors, administrators, personal representatives, successors and assigns, and shall inure to the benefit of the State of Colorado, Colorado Parks and Wildlife, and all other departments, agencies, commissions, boards, institutions, officials, employees, agents of the State and participating sponsors, landowners and volunteers, and their heirs, executors, administrators, personal representatives, assigns and successors in office.

6. ________ Unless I(we, and/or the youth participant) am/are/is able to make a reasoned decision to refuse such assistance at the time it is offered, I give permission to have emergency first aid administered to me(us, the youth participant)at the sole discretion of the agency representative(s) operating/in charge of this event, and, if they deem it appropriate, to transport me(us, and/or the youth participant) by the most expedient means of conveyance to the nearest physician, hospital, or clinic at my cost or the cost of the undersigned consenting parent/guardian.

Certification: I (we) have READ AND INITIALED each paragraph above and understand the obligations, waiver of rights, and other legal consequences contained in each. I have been afforded the opportunity to ask for clarification of any of the statements contained above which I did not understand. I have initialed and signed this document without duress and of my own free will and accord.

(If parent will not be present)I authorize ________________________________________to serve as my child’s guardian during this event/activity. As used in this release, the terms I, we, my, our, his, her, the youth’s, and my person apply regardless of the nature of my involvement with the event/activity and whether or not I personally attend the event/activity or appoint a guardian to act on my behalf. (NOTE: State employees and state volunteers may not act as guardians.) (Initial) _____

DATE: __________ SIGNATURE: __________________________________________________(Youth Participant)

ADDRESS: ______________________________________________________________________________

DATE: __________ SIGNATURE: __________________________________________________(Adult Participant)

ADDRESS: _______________________________________________________________________________

DATE: ___________ SIGNATURE: ___________________________________________________(Parent)

ADDRESS: ________________________________________________________________________________

DATE: ___________ SIGNATURE: ___________________________________________________(Guardian)

ADDRESS: _________________________________________________________________________________

Updated: 9/14/2016