Section 3: Statements to Acknowledge
Statements to Acknowledge
Review the following statements carefully:
Assumption of Risk
I understand not all risks can be foreseen and there are some risks which are unpredictable. I understand inherent risks cannot be eliminated regardless of the care taken to avoid injuries. I am aware of the risks of participation, which include (but are not limited to): the possibility of physical injury, fatigue, bruises, contusions, broken bones, concussion, paralysis and even death. I understand the University of Wisconsin-Whitewater has advised me to seek the advice of my physician before participating in any event(s) affiliated with Club Sports. I understand I have been advised to have health and accident insurance in effect and no such coverage is provided to me by the University of Wisconsin-Whitewater or the State of Wisconsin. I know, understand and appreciate the risks that are inherent to participating in the club(s) named above. I hereby assert that my participation is voluntary and that I knowingly assume all such risks.
Hold Harmless, Indemnity and Release
In consideration of my participation in Club Sports activities, I for myself, spouse, heirs, personal representatives, estate or assigns, agree to defend, hold harmless, indemnify and release the Board of Regents of the University of Wisconsin System, the University of Wisconsin-Whitewater, and their officers, employees, agents, volunteers, and all others who are involved, from and against any and all claims, demands, actions or causes of action of any sort on account of damage to personal property, personal injury or death which may result from my participation in the above-mentioned program(s). This release includes claims based on the negligence of the Board of Regents of the University of Wisconsin System, the University of Wisconsin-Whitewater and their officers, employees, agents, volunteers and all others who are involved, but expressly does not include claims based on their intentional misconduct or gross negligence. I understand that by agreeing to this clause I am releasing claims and giving up substantial rights, including my right to sue.
Consent for Emergency Treatment
I authorize the University of Wisconsin-Whitewater and its designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered upon the advice of any licensed physician. I agree to be responsible for all necessary charges incurred by hospitalization or treatment rendered pursuant to this authorization.
Additional instructions for the previous question. By providing your signature, you acknowledge the contents of the statements listed above and that you are aware of/accept the risks affiliated with participating in the Club Sports program at the University of Wisconsin-Whitewater.
Additional instructions for the previous question. Please list at least one (1) and up to three (3) emergency contacts. List the person’s first and last name, their relationship to you and the best phone number to contact that person. If you have multiple emergency contacts, please separate contact information by hitting the “Enter” key twice. In the event contacting someone becomes necessary, emergency contacts will be contacted in the order in which they are listed.
