Acknowledgement of Risk and Consent
ACKNOWLEDGMENT OF
RISK AND CONSENT FORM
Last Updated: June 9,
2026
Mount Wachusett
Community College
Lifelong Learning and Workforce Development
I acknowledge that I am seeking to participate in the
voluntary class as described by the Division of Lifelong Learning and Workforce
Development (LLL/WFD). I further state that I am at least eighteen (18) years of
age, fully competent to sign this Agreement, and am voluntarily seeking to
participate in this class, or in the case of students under the age of 18, I
further state that I am the parent or legal guardian of the student identified
below and am legally authorized to sign this form on behalf of the student who
is voluntarily seeking to participate in this class. I understand that by
signing this document I am representing that I understand all terms and
conditions and fully intend to be bound by the same terms and conditions. I
also understand that I may wish to consult with my attorney prior to signing
this document.
I acknowledge that there may be certain dangers, hazards,
and risks associated with my participation in this class. I further acknowledge
and understand that all risks cannot be prevented. In light of the risks
associated with this class, I have consulted with my physician and/or health
care provider to discuss whether my participation in this class is appropriate
given my current physical and mental health. Accordingly, I represent that I am
physically and mentally able, with or without accommodation, to participate in
this class, and am capable of using the equipment, if any, associated
therewith.
On behalf of myself (and, if applicable, the participant
identified below), I agree to assume all of the risks and responsibilities
surrounding my participation in this class, and agree to release from liability
and waive any legal action against Mount Wachusett Community College (College),
its governing board, officers, agents, and employees (parties), for personal
injury, death, or property damage suffered by me while participating in this
class or while in transit to or from the premises where the class is being
conducted.
I understand and agree that the College may not provide or
have medical services or personnel available at the location of the class or on
its campus. Therefore, should I require emergency medical treatment as a result
of an accident or illness arising during the class, I consent to such
treatment. Further, I acknowledge that the College does not provide class
participants with health or accident insurance, and I agree to be financially
responsible for any medical bills incurred as a result of emergency medical
treatment provided.
Further, I agree to comply with all rules and regulations
included in the College’s Student Handbook and all other rules as set forth by
the College personnel during the class.
I agree that this document shall be construed in accordance
with the laws of the Commonwealth of Massachusetts. If any term or provision of
this document shall be held illegal or unenforceable, the remaining terms and
provisions shall remain in full force and effect.
