SPORTING EVENTS PARTICIPANTS
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
I, (or hereinafter on behalf of my minor child) ____________________________ (“Participant”), desire to participate in _____________________________ (“Program”) on __________________. I acknowledge that my participation is elective and voluntary. In consideration for being allowed by Eckerd College to participate in the Program, I acknowledge and agree to the following conditions:
RULES AND REQUIREMENTS: I agree to conduct myself in accordance with Eckerd College’s policies and procedures. I further agree to abide by all the Rules and Requirements of the Program. Please see Rules and Requirements, attached as Appendix A. Eckerd College may terminate my participation in the Program if it is determined that my conduct violates any rule or requirement of the Program, is detrimental to the best interests of the Program, or for any other reason in Eckerd College’s discretion.
CERTIFICATION OF FITNESS TO PARTICIPATE: I am physically and mentally fit to participate in the Program and do not have any medical record or history that could be aggravated by my participation.
INFORMED CONSENT: I have been informed of and understand the nature of the Program. I assume full responsibility for my participation in the Program and use of Eckerd College’s facilities. I know that, by participating in the Program, I could sustain serious personal injuries for which protective equipment may be inadequate to prevent. My participation in the Program may result in serious bodily injury to me, including death, as a consequence of not only Eckerd College’s actions, inactions, negligence or recklessness, but also the actions, inactions, negligence or recklessness of others, conditions of the equipment, facility conditions, weather conditions, improper officiating or refereeing, and/or negligent first aid operations. There may be risks not known to me or not reasonably foreseeable. Any injury, illness, damage, disability, or death that I may sustain during or as a result of this Program is my sole responsibility, except as expressly stated otherwise in this Agreement.
NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN: READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF ECKERD COLLEGE USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER FROM ECKERD COLLEGE IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND ECKERD COLLEGE HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.
I further acknowledge that I have read and understand the attached NCAA Concussion Fact Sheet [see Appendix B] and am aware of the following information:
1. A concussion is a brain injury for which I am immediately responsible for reporting to Eckerd College’s staff.
2. A concussion can affect my ability to perform everyday activities, including reaction time, balance, sleep, concentration and classroom performance.
3. It is my responsibility to report to Eckerd College’s staff if I receive a blow to the head or body and experience signs or symptoms of a concussion or brain injury, which may include: headache, blurred vision, weakness in one arm or leg, loss of consciousness, stumbling, loss of balance, nausea/vomiting, confusion, memory loss, or change in personality (including irritability and depression). I understand that I must report this immediately and as soon as I am physically capable of doing so.
4. I may notice some symptoms of a concussion immediately, but other symptoms may show up hours or days after the initial injury. It is my responsibility to report any delayed signs or symptoms to Eckerd College’s staff.
5. If I suspect a fellow camper has a concussion, I am responsible for immediately reporting his or her injury to Eckerd College’s staff.
6. I will not return to play in a game or practice if I have received a blow to the head or body that results in concussion-like symptoms until I am cleared by a member of Eckerd College’s staff.
7. Following a concussion, the brain needs time to heal. I am more likely to have a repeat concussion if I return to play before my symptoms resolve. In rare cases, repeat concussions can cause permanent brain injury or death. Because of this, I understand it is important to accurately report all continuing signs and/or symptoms if I have been diagnosed with a concussion.
ASSUMPTION OF RISKS: There are potential dangers incidental to my participation in the Program, including sprains, strains, shin splints, stress fractures, wrist fractures, shoulder dislocations, cuts, bruises, neck sprains and concussions [see Appendix B], risks of damage, bodily injury, and possibly death. Potential dangers may result from practicing, training, observing, and competing in Program events. Potential dangers may also stem from weather conditions, facility conditions, equipment conditions, negligent first aid operations, improper officiating or refereeing, procedures of Eckerd College, and other risks that are unknown at this time. Risks may result from the Program’s activity itself, from the acts of others, from use of the equipment or facilities, or organization of or unavailability of emergency medical care. Participation in the Program involves activities incidental thereto and the possible reckless conduct of other participants. I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, BOTH KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE ACTS OF ECKERD COLLEGE, including its governing board, trustees, directors, officers, employees, and any students, agents or volunteers acting at Eckerd College’s direction (collectively referred to herein as “ Eckerd College”) UNLESS THE RISKS ARISE FROM ECKERD COLLEGE’S NEGLIGENCE, RECKLESSNESS, OR INTENTIONAL MISCONDUCT.
RELEASE AND WAIVER OF LIABILITY: I, on behalf of myself, my personal representatives, heirs, executors, administrators, agents, and assigns, HEREBY RELEASE, WAIVE, DISCHARGE, AND AGREE NOT TO HOLD Eckerd College responsible for any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys’ fees and costs), arising from any injury, damage or death that I may suffer as a result of my participation in the Program, REGARDLESS OF WHETHER THE INJURY, DAMAGE OR DEATH IS CAUSED BY ECKERD COLLEGE UNLESS THE INJURY, DAMAGE OR DEATH IS CAUSED BY ECKERD COLLEGE’S NEGLIGENCE, RECKLESSNESS, OR INTENTIONAL MISCONDUCT, AND REGARDLESS OF WHETHER THE INJURY DAMAGE OR DEATH OCCURS WHILE ON, UPON, OR IN TRANSIT TO/ FROM THE PREMISES WHERE THE PROGRAM, OR ANY LOCATION ADJUNCT TO THE PROGRAM OCCURS OR IS BEING CONDUCTED.
Eckerd College expressly disclaims liability for actions of third parties, including but not limited to participants, students, agents or volunteers who are not acting under the direction and control of Eckerd College. I release Eckerd College from any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys' fees), arising from any injury, damage or death that I may suffer as a result of actions of any third parties who are not Eckerd College.
Eckerd College is not in any way responsible for any injury or damage that I sustain as a result of my own negligent or reckless acts or my own intentional misconduct and I hereby release Eckerd College from any liability for the same.
INDEMNITY: I, on behalf of myself, my personal representatives, heirs, executors, administrators, agents, and assigns, agree to hold harmless Eckerd College from any and all liability, including any and all claims, demands, causes of action (known or unknown), suits, or judgments (including attorneys’ fees and costs), arising from any injury, damage or death that I may suffer as a result of my participation in the Program, REGARDLESS OF WHETHER THE INJURY, DAMAGE OR DEATH IS CAUSED BY ECKERD COLLEGE OR OTHERWISE UNLESS THE INJURY, DAMAGE OR DEATH IS CAUSED BY ECKERD COLLEGE’S NEGLIGENCE, RECKLESSNESS, OR INTENTIONAL MISCONDUCT.
In the event that I or any of my family members, personal representatives, heirs, executors, administrators, agents, assigns or any other third party attempts to assert any claims, demands, causes of action (known or unknown), suits, or judgments (including attorneys' fees), arising from any injury, damage or death to me, including but not limited to any injury resulting from my own negligence, recklessness, or intentional misconduct during or related to the Program, I AGREE TO DEFEND AND INDEMNIFY ECKERD COLLEGE AGAINST SUCH CLAIMS, DEMANDS, CAUSES OF ACTION (KNOWN OR UNKNOWN), SUITS, AND/OR JUDGMENTS OF ANY AND EVERY KIND (INCLUDING ATTORNEYS' FEES AND COSTS).
PERSONAL MEDICAL INSURANCE: I have my own personal medical insurance and am responsible for the cost of any and all medical services that I may require as a result of participating in the Program, except for medical costs arising from an injury that I sustain that is the direct result of Eckerd College’s negligence, recklessness, or intentional misconduct.
MEDICAL CONSENT: I understand and agree that Eckerd College does not have medical personnel available at the location of the Program or while traveling for the Program. In the event of any medical emergency:
• I (initial one) do____/do not____ authorize and consent to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment and hospital care that Eckerd College personnel deem necessary for my safety and protection.
In the event that I experience any condition requiring emergency medical treatment:
• I (initial one) do____/do not____ authorize and consent to be transported to the hospital for such care.
I understand and agree that Eckerd College assumes no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment or transportation.
PROMOTIONAL RIGHTS: Eckerd College has the right to use, for promotional purposes only, any photographs of me taken by Eckerd College’s employees or agents, during my participation in the Program. Eckerd College may use any statements or quotes attributed to me in my evaluation of the Program for marketing purposes.
CHOICE OF LAW: This Agreement shall be construed in accordance with the laws of the State of Florida.
SEVERABILITY: If any term or provision of this Agreement shall be held illegal, unenforceable, or in conflict with any law governing this Agreement, the validity of the remaining portions shall not be affected thereby.
I hereby acknowledge that I have read, understand and will abide by each of the terms and conditions of this Agreement. I understand that I may seek legal counsel of my own choosing to fully explain any terms of this Agreement to me before I sign it.
Date: ___________________ __________________________________________
(Printed Name of Participant)
Signature of Parent/Guardian for Participants Who Are Minors:
I certify that I have custody of Participant or am the legal guardian of Participant by court order. I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND AND AGREE TO ITS TERMS. I AM AWARE THAT THIS AGREEMENT INCLUDES A RELEASE AND WAIVER OF LIABILITY, AN ASSUMPTION OF RISK, AND AN AGREEMENT TO INDEMNIFY ECKERD COLLEGE.
Date: ____________________ __________________________________________
(Signature of Parent or Guardian)
(Printed Name of Parent or Guardian)