Stress Management Course

Informed Acknowledgement of and Consent To Activity Hazards and Risks

All participants must sign and send a signed copy to the instructor at the time of registration for the course. You may download and send email or fax the following:

I,___________________________________ hereby acknowledge and certify the following. I understand that in connection with my voluntary participation in this travel course there are inherent risks and I accept personal responsibility for my own actions. I understand that I am not permitted to use,  and I specifically agree and declare that I will not use, alcohol or drugs during any college-sponsored class time or activity. I certify that I am in excellent health and have no medical, physical or emotional impairments. Conditions, or concerns, which might inhibit my participation, jeopardize my safety of the safety of others while participating, in this travel course. I understand that neither the college, nor the instructor, nor any of its agents serve as guard of insurers of my safety, and that the college does not provide special insurance for protection.

I understand that if I drive, or provide my own motor vehicle for transport to, during or from the activity site, I am responsible for myself and the security of my vehicle. Green River Community College, or the instructor, do not cover any damage or injury suffered in the course of traveling in private vehicles. I understand that there are certain dangers associated with my participation in the stress management course, including accidents, illness, and any other harm, injury or damage which may befall me as a result of ( list specific activities, hazards, risks): or any other program related activity. I freely and voluntarily accept such risks and Green River Community College and all its agents free from liability in the event I suffer personal or property injury or damage because of, or in the course of, participating activity.

In case of emergency, I request that the college contact:

Name           Address                 Telephone Number

I realize that I may be required to acknowledge and complete additional waivers that may be presented to myself by other organizations in addition to the statement of Informed Acknowledgement and Consent. I hereby voluntarily sign this document and knowingly assume described risks associated with participating in the activity.

I have fully informed myself of the contents of the  Acknowledgement by reading it before I signed it. I certify under the penalty of perjury under the laws of the State of Washington the foregoing is true and correct.

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If you are under 18 years of age, please have your parent or legal guardian in addition sign below.

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