Rutgers Recreation


Standard Safe Practices Statement of Understanding- G

PLEASE PRINT

  Club:         E-mail:         NetID         RUID

  First Name         Last Name     Semester 

  Emergency Contact          Emerg. Phone:

  School Address     City    State     ZipCode

  Home Address      City   State     ZipCode

  Preferred Mailing Address   Primary Phone   Home Phone      DOB  

  Affiliation   Residential Campus    Year of graduation

  Title/Department     College     Major   Class

  Personal Insurance    CPR      CPR Exp. Date    First Aid      FA Exp. Date    Van Driver

  This is a statement in which you are informed of the established safe practices for participation in a Sport Club program. These practices have been compiled for your review and acknowledgementand are intended to increase your comfort and safety in participating in your Sport Club.Please initial beforeeach paragraph.Your signature on this statement is required as proof that you are aware of these safety practices. Read and discuss the statement prior to signing it. If you are a minor, a parent or a guardian must also sign this form.

    I voluntarily agree to assume all risks involved in participating in the club and/or traveling to and from participation sites.

    I understand that supervision by Rutgers staff is not provided and is under no obligationto do so.

    I recognize that I may expose myself to injuries including but not limited to temporary or permanent muscle soreness, sprains, strains, cuts, bruises, abrasions, ligament and/or cartilage damage, head, neck, or spinal injuries, loss of use of arms and/or legs, eye damage, disfigurement or even death.

    I also recognize that there are foreseeable and unforeseeable risks of injury or death that may occur as a result of my participation in the above named sport that cannot be specifically listed.

    It is expressly understood by the undersigned that he/she is solely responsible for any costs arising out of bodily or property damage sustained through participation in recreational activities.

    I understand that it is strongly encouraged that I consult with a physician before participating in any recreational activities to determine any potential hazards that may adversely affect my participation.

    I understand that anyone with a pre-existing condition is encouraged to have an I.D. bracelet or tag that lists all information vital to the condition.

 

   I understand that as a Sport Club athlete I should:

   Maintain good mental and physical fitness for the sport. Avoid being under the influence of alcohol or dangerous drugs when participating. Keep proficient in my sport skills, striving to increase them through continuing education and reviewing them in controlled conditions after a period of inactivity.

   Be familiar with my sport. If not, obtain a formal orientation from a knowledgeable, local source. Do not engage in any Sport Club event unless specifically trained to do so.

   Use complete, well-maintained, reliable equipment with which I am familiar; and inspect it for correct fit and function prior to each use.

 

    I affirm, to the best of my knowledge that I am in good physical and mental health and free from cardiovascular, respiratory or other diseases or ailments, which could endanger my performance.

     I affirm that I am of lawful age and legally competent to sign this waiver, or that I have acquired the written consent of my parent or guardian.

     In full awareness of the above and in consideration of my participation in Sport Club activities, I waive, releaseand discharge any and all claims for death, personal injury or property damage against Rutgers, The State University, its officers, agents and employees, which I may have, or which may hereafter accrue to me as a result of my participation in the Sport Club. I agree to indemnify and hold harmless Rutgers,The State University, its officers, agents and employees from any claim or loss for death, bodily injury or property damage arising in any manner out of my presence or activities in the course of participation in my Sport Club activities. I further understand and agree that this waiver, release indemnity and assumption of risk is to be binding on my heirs and assigns.

 I have fully informed myself of the contents of this Informed Consent and Waiver form by reading it before I signed it on behalf of myself, my heirs, and assigns

 (Signature by typing Name)   (Date)