Others Affected. I intend that this Agreement is and will be binding on my family, estate, heirs, successors, assigns, insurers, medical providers and personal representatives. By my signature, I agree and represent that: I have entered into this Agreement on the basis of my own assessment of the risks involved and not in reliance upon representations of the University, its employees, officers or agents; I understand that I have the right to consult an attorney of my choice before signing this Agreement; I further understand that this Agreement contains our entire agreement, and that it cannot be modified except in a writing signed by me and the University; Alaska law applies to this Agreement and any dispute will be resolved in the state court located in Fairbanks, Alaska; If any part of this Agreement is found to be invalid or unenforceable for any reasons, the balance of the Agreement remains valid and enforceable; This a legally binding agreement designed to protect the “University” from claims that could be brought by myself or anyone else because of “xxxxx” to me. PARTICIPANT’S NAME: DATE: (Please Print) ADDRESS: TELEPHONE: PRINT NAME: DATE: SIGNATURE: DATE: MODEL RELEASE PORTION - OPTIONAL
Others Affected. I intend that this Agreement is and will be binding on my family, estate, heirs, successors, assigns, insurers, medical providers and personal representatives. By my signature, I agree and represent that: I have entered into this Agreement on the basis of my own assessment of the risks involved and not in reliance upon representations of the University, its employees, officers or agents; I understand that I have the right to consult an attorney of my choice before signing this Agreement; I further understand that this Agreement contains our entire agreement, and that it cannot be modified except in a writing signed by me and the University; Alaska law applies to this Agreement and any dispute will be resolved in the state court located in Fairbanks, Alaska; If any part of this Agreement is found to be invalid or unenforceable for any reasons, the balance of the Agreement remains valid and enforceable; This a legally binding agreement designed to protect the “University” from claims that could be brought by myself or anyone else because of “xxxxx” to my child or me. PARTICIPANT’S NAME: DATE: (Please Print) ADDRESS: TELEPHONE: PRINT NAME: DATE: (PARENT/LEGAL GUARDIAN) SIGNATURE: DATE: (PARENT/LEGAL GUARDIAN) MODEL RELEASE PORTION - OPTIONAL (PARENT/LEGAL GUARDIAN SIGNATURE) On
