Liability Waiver and Release from Federal and State Claims

LIABILITY WAIVER AND RELEASE FROM

FEDERAL AND STATE CLAIMS

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(Please Print Information) ALL BLANKS MUST BE FILLED IN.

Name: Phone:

Address: City/State:

Zip Code:

I acknowledge that _______________________________________________ (Agency) is willing to

authorize me to participate and engage in activities associated with Agency and on property owned or

leased by the State of Oregon. I understand that there are risks and dangers inherent with my

performance of and participation in these activities, including but not limited to, possible property damage,

personal injury, or death.

In exchange for Agency’s authorization to participate and engage in the activities, I EXPRESSLY AGREE

TO SAVE AND HOLD HARMLESS AGENCY, THE STATE OF OREGON, AND THEIR OFFICERS,

EMPLOYEES AND AGENTS FROM AND AGAINST ALL CLAIMS, SUITS, ACTIONS, PROCEEDINGS,

LOSSES, DAMAGES, LIABILITIES, AWARDS AND COSTS OF EVERY KIND AND DESCRIPTION,

INCLUDING ANY AND ALL FEDERAL AND STATE CLAIMS, REASONABLE ATTORNEY'S FEES, AND

EXPENSES AT TRIAL (COLLECTIVELY “CLAIMS”) WHICH I HAVE OR MAY HAVE A RIGHT TO BRING

AGAINST ANY AGENCY, THE STATE, OR THEIR AGENTS, OFFICIALS, EMPLOYEES ARISING OUT

OF OR RELATED TO MY PARTICIPATION AND PERFORMANCE OF THE ACTIVITIES, INCLUDING

BUT NOT LIMITED TO CLAIMS FOR ANY PERSONAL INJURY, DEATH OR PROPERTY DAMAGE

CAUSED BY ANY ALLEGED ACT, OMISSION, ERROR, FAULT, MISTAKE OR NEGLIGENCE OF

AGENCY, THE STATE OF OREGON, AND THEIR OFFICERS, EMPLOYEES AND AGENTS.

I further agree that the provisions of this Liability Waiver and Release from Federal and State Claims

shall be effective and binding upon my heirs, executors, administrators, successors, assigns,

beneficiaries, or delegatees and shall inure to the benefit of Agency, the State of Oregon, and their

officers, employees and agents.

By my signature and execution of this form, I acknowledge and agree that I have read this Liability

Waiver and Release from Federal and State Claims and understand the rights and claims that I am

giving up. I, FOR MYSELF, AND ON BEHALF OF MY HEIRS, EXECUTORS, ADMINISTRATORS,

SUCCESSORS, ASSIGNS, BENEFICIARIES, OR DELEGATEES, HEREBY RELEASE AND FOREVER

DISCHARGE AGENCY, THE STATE OF OREGON, AND THEIR OFFICERS, EMPLOYEES AND

AGENTS, FROM ANY AND ALL DEMANDS AND CLAIMS, KNOWN OR UNKNOWN, THAT I HAVE OR

MAY HAVE AGAINST AGENCY, THE STATE OF OREGON, AND ITS OFFICERS, AGENTS OR

EMPLOYEES FOR ANY AND ALL HARM OR DAMAGE TO MY HEALTH OR PROPERTY IN ANY

MANNER RESULTING FROM OR ARISING OUT OF MY PARTICIPATION IN AND PERFORMANCE

OF ACTIVITIES ASSOCIATED WITH AGENCY.

This release does not extend to or waive any rights I may have under the Oregon Tort Claims Act, ORS

30.260-300, as those rights relate to defense and indemnification from any demand, claim, suit or action

brought against me, or liability I may be subject to, or arising out of my participation or performance of

activities associated with Agency.

Signature: Date:

PARENT OR LEGAL GUARDIAN’S AUTHORIZATION FOR CONSENT TO AGREEMENT

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I, ____________________________________, as parent or legal guardian hereby grant permission for

________________________________ to perform, participate, and engage in activities associated with

__________________________________________ (Agency). By my signature below, I hereby

acknowledge that I have read, understand, and consent to this Liability Waiver and Release from

Federal and State Claims.

Signature: Date:

(Parent or Legal Guardian signature required if participant is under age 18 years.)