Blackhawk Rec Center Waiver Form

Recreational use of the Blackhawk Rec Center facility is limited to approved members.

All persons wishing to utilize the Blackhawk Rec Center are required to sign a BRC Waiver and Release of Liability Form and possess and present a current Blackhawk ID at the time they use the facility.

Verification of status and distribution of the Blackhawk ID may take up to 48 hours after applying to use the Blackhawk Rec Center.

Members will be charged $15 to replace a Blackhawk Card ID.

Name*

First NameLast Name

Please select the appropriate category*

Currently Enrolled SCC Student (currently enrolled in at least one credit hour)SCC Staff/Faculty/AdjunctCommunity Member (track use only)SCC Concurrent Enrolled Student (high school students who are taking SCC credit classes while also enrolled in high school)SCC Staff family member (child or spouse)

If you are a SCC Faculty, Staff or Student, which campus do you attend for class or work?*

If you are a SCC Student or Faculty/Staff please indicate your ID number (For SCC Employee: The ID is located on the back of employee badge)

SCC Email*

example@example.com

Home or Current Address*

Street Address

Street Address Line 2

CityState / Province/Country

Postal / Zip Code

Cell Phone Number*

Please enter a valid phone number.

Birth Year*

Date

PARTICIPANT RELEASE AND INDEMNIFICATION / HOLD HARMLESS AGREEMENT

I am aware of the risks and hazards involved in the above identified use of SCC facilities and exercise / fitness equipment/classes. I fully understand and acknowledge that a risk of injury from participation in fitness activities exists, and a resulting injury could be significant, including but not limited to: permanent injury and/or death. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS AND HAZARDS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES (as described below) or others, and assume full responsibility for my use of exercise equipment and voluntarily elect to participate in fitness activities.

I understand the nature of the activity in which I am agreeing to participate involves physical exertion and a degree of physical agility on my part. I represent that I am physically able to participate in the activity, and that I have no condition that may prevent me from participating.

I agree to comply with the stated and customary terms and conditions for participation in fitness activities, and to take steps that I determine necessary to reduce my risk of injury, including but not limited to: assessment of my ability to participate in activities. If I observe any unusual or significant hazard or risk to myself during my participation in activities, I will take the necessary actions to remove myself from the hazard or risk immediately.

In addition, in consideration of and as a condition of SCC permitting me to use the facility and equipment, and to participate in fitness activities, I agree to assume all risks of damage and injury (including death) which may be sustained by me while on SCC premises and/or using the equipment. I, on my own behalf, and acting on behalf of my spouse, children, heirs, personal representatives and assigns, do hereby release, indemnify and hold harmless SCC, other activity participants, sponsors, individually and collectively, and all of the above named parties, directors, officers, agents, employees and students (collectively Releases) WITH RESPECT TO ANY AND ALL INJURIES, INCLUDING: DEATH OR LOSS OF OR DAMAGE TO PERSONAL PROPERTY, PSYCHOLOGICL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONIMIC OR EMOTIONAL LOSS, WHETHER ARISING FROM THE NEGLIGENCE OF ANY RELEASEE OR OTHERWISE, AND ANY / ALL CLAIMS, DAMAGES, LOSSES AND EXPENSES ARISING DIRECTLY OR INDIRECTLY BY ACT OR OMISSION OF ANY RELEASEE, resulting from, or arising out of , my use of SCC Facility and fitness / exercise equipment.

In signing this consent to use SCC facilities and exercise / fitness equipment, I hereby acknowledge and represent: (1) that I have read this document in its entirety, understand it, and sign it voluntarily; (2) that I am of legal age; and (3) that this consent to use College Facilities and exercise / fitness equipment is the entire document between the parties hereto and its terms are contractual and not mere recital.

Participant Signature*

Date*

In order to use the Blackhawk Rec Center, an individual must have a Blackhawk ID Card with a valid photo. Please submit one color photo, use a clear image of your face, and use a white background. (Please note: To speed up the process please submit your photo ID here. Any photo not uploaded will be taken at the Blackhawk Rec Center)

Blackhawk Rec Center Release/ID Form