Gallagher Center Waiver and Release Form

Jefferson University(“university”) is making available to its students, faculty and staff the use of the Gallagher Center on its East Falls campus in Philadelphia PA during the posted hours. The Gallagher Center is comprised of the fitness area, gymnasiums, courts and jogging track, as well as, all common areas and locker rooms.

I, the undersigned, understand and agree that the use of the Gallagher Center is voluntary. Intending to be legally bound, I hereby assume the entire risk of injury and agree to indemnify, hold harmless and release the University, its directors, officers, employees, agents, representatives, their successors and assigns, from any liability and all claims I have or may have against the University for injuries of any nature sustained by me as a result of my use or misuse of the Gallagher Center and equipment therein.

I further acknowledge and understand the following:

  • I have consulted a physician and have been cleared to use the Gallagher Center and the equipment therein, and certify that I am not suffering from any physical condition that constitutes a physical risk to others or myself.
  • This release is given in consideration of my being permitted to use the Gallagher Center and its equipment, and further, without the execution of this release I would not be permitted to use such facilities.
  • Although the University is supplying equipment which it has purchased for use in the Gallagher Center, the University makes no representation or warranty, either expressed or implied, that the equipment is fit for any particular purpose.
  • My use of the Gallagher Center is solely at my own risk, and I assume all responsibility for injury to myself or to others from any use of misuse of the equipment.
  • I give permission to be videotaped during classes, which may be posted to the Fitness Center website.

I have reviewed the rules and regulations of the Gallagher Center (available on the University Athletics website) and agree to abide by such rules now in effect or hereafter in force. In addition, I agree that the equipment in the Gallagher Center will be used in strict conformity with posted instructions found on or at each piece of equipment.

Name: ______

Campus ID #______Expected Graduation Year: ______

Student:_____ Faculty/Staff:______Guest: _____ Retiree:______

Emergency Contact:______Emergency Phone Number: ______

I have carefully read this agreement and fully understand it.

Signature: ______Witness Signature: ______

Date: ______Date:______

Print Name: ______Print Name: ______

PLEASE RETURN TO DIRECTOR OF FITNESS AND WELLNESS