BUCS FITNESS CLUB 
WAIVER AND RELEASE OF LIABILITY 
In agreeing to become a member of the UVI Fitness Room, I agree to the following: 
I, _____________________________________, fully understand and acknowledge that BUCS 
Fitness Club and activities organized in the BUCS Fitness Club have (a) inherent risks, dangers, 
and hazards and such exists in my use of any equipment and my participation in these 
activities; (b) use of such equipment and/or my participation in such activities may result in injury 
or illness including, but not limited to bodily injury, disease, strains, fractures, partial and/or total 
paralysis, death or other ailments that, could cause serious disability; (c) these risks and 
dangers may be caused by the negligence of the representatives, employees, or volunteers of 
University of the Virgin Islands, the negligence of the participants, the negligence of others, 
accidents, breaches of contract, or other causes; (d) by my use of the equipment and 
participation in these activities, I hereby assume all risks and dangers and all responsibility for 
any losses and/or damages whether caused in whole or in part by the negligence or the conduct 
of the representatives, employees, or volunteers of University of the Virgin Islands Fitness 
Room, or by any other person. 
I, on behalf of myself, my personal representatives and my heirs, hereby voluntarily agree to 
release, waive, discharge, hold harmless, defend, and indemnify the University of the Virgin 
Islands and its representatives, employees, and volunteers from any and all claims, actions or 
losses for bodily injury, property damage, wrongful death, loss of services or otherwise which 
may arise out of my use of any equipment or participation in these activities. I specifically 
understand that I am releasing, discharging, and waiving any claims or actions that I may have 
presently or in the future for the negligent acts or other conduct by the representatives, 
employees, and volunteers of University of the Virgin Islands. 
I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE. IT IS MY 
INTENTION TO EXEMPT AND RELIEVE THE UNIVERSITY OF THE VIRGIN ISLANDS FROM 
LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH 
CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE. 
Member's Name (print)  _______________________________    
Date of Birth ______/_____/______ 
Address ________________________________________________________________________________ 
Contact Nos. ____________________________________________________________________________ 
Member’s Signature ______________________________________ 
Date ________________________ 
 
 
 
 
 
 
 
 
 
 
 
 
 
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For Office Use Only 
Date Received in Office: 
_______/_______/_________ 
Form Received by: ___________________________________