PLEASE READ CAREFULLY, THIS AGREEMENT IS LEGALLY BINDING. By signing below you give up your right to recover compensation through the courts or otherwise, for any damage to yourself, including death, or damage to personal equipment while attending the activity sponsored by the Iowa State University Mountaineering and Climbing Club. For the activities including, but not limited to CLIMBING, RAPPELLING, BACKPACKING, HIKING AND ALL ASPECTS OF MOUNTAINEERING ON THE BLUE MOUNDS, SOUTH WEST MINNESOTA TRIP.

This includes transportation to and from all destinations.

I, the undersigned agree that the nature of the activities associated with this trip are inherently dangerous and may result in personal injury or death.

I, the undersigned, hereby release, waive, discharge and covenant not to sue the State of Iowa, the Board of Regents of the State of Iowa, Iowa State University, Iowa State University Mountaineering and Climbing Club, and any of the advisors, officers, servants, agents and employees of the above mentioned entities (hereinafter referred to as RELEASEES) for any liability, claim and/or cause of action arising out of or related to any loss, damage or injury, including death, that occurs as a result of the undersigned, participation in the above listed activity.

I agree to indemnify and hold harmless the RELEASEES whether injury is caused by my negligence, the negligence of the RELEASEES or the negligence of any third party. I further agree that this Release of all Claims and Waiver of Liability shall bind the members of my family and spouse, if I am alive, and heirs, assigns and personal representatives, if I am deceased, and shall be deemed as a RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE the above-named RELEASEES. I hereby further agree that this Release of all Claims and Waiver of Liability shall be construed in accordance with the laws of the State of Iowa.

By signing this Release of all Claims and Waiver of Liability, I state that I have read and understand the conditions set forth in this Release and that I agree to all conditions set forth in this Release and that I agree to all conditions set forth herein, and that I sign this voluntarily.

In addition to the above waiver, I must also show proof that I have health insurance and am in good standing with my insurer, or I will not be able to participate in the said event.

Name Health Insurance Company Policy Number Signature Date Person to Contact in case of Emergency Relationship to you Their Phone Number	_________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________ _________________________