GLENDALE UNIFIED SCHOOL DISTRICT

Release of Liability and Assumption of Risk Agreement

ATHLETICS, CHEER/STUNT & INTERSCHOOL EXTRA/CO-CURRICULAR ACTIVITIES

STUDENT NAME SCHOOL:

CHECK ALL APPLICABLE ACTIVITIES: LIST ALL OTHER SCHOOL-SPONSORED ACTIVITIES

 Baseball  Lacrosse  Swimming/Diving
 Basketball  Mountain Biking  Tennis
 Cheer/Stunt  Powder Puff  Track
 Cross-Country  Skiing/Snowboarding  Volleyball
 Football  Soccer  Water Polo
 Golf  Softball  Wrestling

This is a Release of Liability and Assumption of Risk Injuries might arise from the student’s actions or inactions, the
Agreement. Read it carefully and sign below. Completion of this actions or inactions of another student or participant, or the actual or
release is a prerequisite to participation in an inter-scholastic athletic alleged failure by district employees, agents, or volunteers to
activity or designated school-sponsored activity/school club or adequately coach, train, instruct, or supervise. Injuries might also
(hereinafter collectively referred to as “school-related activity/ies”). arise from an actual or alleged failure to properly maintain, use,
This release essentially says that my son/daughter or I, as a student repair, or replace physical facilities or equipment. Injuries might
at least 18 years of age, named above (hereinafter “above-named also arise from undiagnosed, improperly diagnosed, untreated,
student”), has my consent and will participate in the school-related improperly treated, or untimely treated actual or potential injuries,
activities as specified above. whether or not caused by the student’s participation. All such risks
are deemed to be inherent to the student’s participation in school-
If (student) is related activities.
hurt, injured, or even dies, I/we (i.e., the student, his/her parent/s, In consideration for GUSD, allowing the above-named student
guardian/s, heir/s . . .) will not make a claim against or sue the to participate in the school-related activity/ies specified above, I/we
Glendale Unified School District (hereinafter GUSD), its trustees, voluntarily agree to release, waive, discharge, and hold harmless the
officers, employees, and agents, or expect them to be responsible or GUSD and its trustees, officers, employees, and agents from any and
pay for any damages. all claims of liability arising out of their negligence, or any other act
I, the undersigned, understand and acknowledge that the or omission which causes the above-named student illness, injury,
above-named student has voluntarily chosen to participate in school- death or damages of any nature in any way connected with the
related activities at his/her own risk. I/We know and fully student’s participation in the school-related activity/ies. I/We also
understand that said school-related activities may involve numerous expressly agree to release and discharge GUSD, its trustees, officers,
risks, dangers, and hazards, both known and unknown, where employees, and agents from any act or omission of negligence in
serious accidents can occur, and where participants can sustain rendering or failing to render any type of emergency or medical
physical injuries, damage to their property, or even die. Regardless services.
of whether the school-related activity involves physical contact or As parent or legal guardian of the student/participant under 18
not, any activity may have inherent risks of injury which are years of age, I have read and voluntarily agree that my son/daughter
inseparable from the activity. I/We acknowledge and willingly may participate in the school related activity/ies designated above
assume all risks and hazards of potential injury, paralysis, and death and I sign this release on his/her behalf. I understand and
in the school-related activity/ies, including any transportation to or acknowledge that participation in school related activity/ies is
from any school-related activity/ies. Further, by giving consent for completely voluntary and not required by the Glendale Unified
this student to go with a school representative, it is acknowledged School District for course credit or for completion of graduation
that the activity/ies will be considered a “field trip” or “excursion” requirements. In signing this document I fully recognize and
for which there is complete immunity pursuant to Education Code understand that if my son/daughter is hurt, dies, or his/her property
§35330. is damaged, I am giving up my right and the right of his/her heirs to
I/We, the undersigned, understand and acknowledge that make a claim or file a lawsuit against the GUSD, its trustees, officers,
school-related activity/ies contain potential risks of harm or injury. employees, and agent.

By signing below, I/we acknowledge that I/we: (1) have read this document and understand that I/we give up substantial actual or potential
rights in order to allow the above-named student to participate in the school-related activity/ies and any associated field trip or excursion;
(2) have voluntarily signed as evidence of acceptance of this Agreement without any inducement or assurance of any nature, with full
appreciation of all the risks inherent in the school-related activity/ies; (3) have no question regarding the scope or intent of this Agreement
and I (parent/guardian/non-minor student) have the right and authority to enter into this Agreement and to bind myself, the student, and
any other family member, personal representative, assign, heir, trustee, or guardian to the terms of this Agreement. This is a release of
all claims.
Both signatures must be in pen. No electronic signatures of any kind will be approved.
DATE: x
Signature of Parent/Legal Guardian or Non-minor Student/Participant*

DATE: x
Signature of Minor Student/Participant

*A student 18 years of age or older is considered, by law, a non-minor and may sign form in the place of a parent and assumes all of the above-
stated risks and liabilities for himself/herself.

Revised May 24, 2022