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    Medical Waiver

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    CheerBU
    This document contains two consent forms for student-athletes at Boston University. The first form grants permission for medical treatment and the release of medical information. It allows BU athletic training staff to provide needed care and processing of insurance claims. The second form acknowledges the risks of injury from participation in sports. It waives claims against BU for ordinary negligence by the student-athlete or their guardian. Both forms require signatures from the student-athlete and their parent/guardian if under 18.

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    Medical Waiver

    Uploaded by

    CheerBU
    449 views1 page
    This document contains two consent forms for student-athletes at Boston University. The first form grants permission for medical treatment and the release of medical information. It allows BU athletic training staff to provide needed care and processing of insurance claims. The second form acknowledges the risks of injury from participation in sports. It waives claims against BU for ordinary negligence by the student-athlete or their guardian. Both forms require signatures from the student-athlete and their parent/guardian if under 18.

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    BU Athletic Training Services medical waiver. Please read, sign, and date this form.

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    This document contains two consent forms for student-athletes at Boston University. The first form grants permission for medical treatment and the release of medical information. It allows BU athletic training staff to provide needed care and processing of insurance claims. The second form acknowledges the risks of injury from participation in sports. It waives claims against BU for ordinary negligence by the student-athlete or their guardian. Both forms require signatures from the student-athlete and their parent/guardian if under 18.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    449 views1 page

    Medical Waiver

    Uploaded by

    CheerBU
    This document contains two consent forms for student-athletes at Boston University. The first form grants permission for medical treatment and the release of medical information. It allows BU athletic training staff to provide needed care and processing of insurance claims. The second form acknowledges the risks of injury from participation in sports. It waives claims against BU for ordinary negligence by the student-athlete or their guardian. Both forms require signatures from the student-athlete and their parent/guardian if under 18.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Boston University Athletic Training Services 285 Babcock Street Boston, MA 02215

    CONSENT TO TREAT AND MEDICAL INFORMATION RELEASE


    To be read and signed by the Student-Athlete and the Parents / Guardian if the Student-Athlete is under 18 years old. Permission is hereby granted by the undersigned to Boston University to proceed with any needed medical or minor surgical treatment, x-ray examination, imaging studies or testing, in the best interests of the student-athlete named below. This authorization permits the Boston University Athletic Training Services staff, physicians, and consultants to obtain and release medical information and records in the course of medical treatment and for the purpose of processing insurance claims. I understand and agree that general information about my injury / condition may be discussed with the staff and personnel of the BU Athletic Department or Physical Education, Recreation & Dance only as it affects my participation in physical activity. This Release and Authorization is a required condition for participation in the athletic program and shall remain valid until revoked in writing. _____________________________________ Signature of Student-Athlete _____________________________________ Name of Parent/Legal Guardian (PRINT) (if student-athlete is under 18) ________________ Birthdate (mm/dd/yy) _________ Age ___________________ Date (mm/dd/yy) ___________________ Date (mm/dd/yy)

    _________________________________ Signature of Parent/Guardian

    INFORMED CONSENT AND WAIVER OF CLAIM FORM


    To be read and signed by the Student-Athlete and the Parents / Guardian if Student-Athlete is under 18 years old. I am aware that participating in any sport can be a dangerous activity involving many RISKS OF INJURY. I understand that the dangers and risks of participating in sports include, but are not limited to death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all internal organs, serious injury to virtually all bones, joints, ligaments, muscles, tendons, and aspects of the muscular system, and serious injury or impairment to other aspects of my body, general health, and well being. I understand that the dangers and risks of participating in sport may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, engage in other business, social and recreational activities, and generally enjoy life. Because of the dangers of participating in sports, I recognize the importance of following coachs instructions regarding playing techniques, training and other team rules, etc., and to agree to obey such instructions. In consideration of being presented this opportunity to participate in intercollegiate sports at Boston University and in acknowledging that I am aware of and willing to assume the risks associated with intercollegiate sports, I hereby voluntarily agree to waive, hold harmless and indemnify Boston University and its trustees, agents, volunteers and employees from any and all claims, demands, damages and causes of action of any nature whatsoever arising out of ordinary negligence which I, my heirs, my assigns or successors may have against them for, on account of, by reason of my voluntary participation in intercollegiate sports while at Boston University. I understand the content of this document, and I execute this INFORMED CONSENT AND WAIVER OF CLAIM form of my own free will and accord. _____________________________________ Signature of Student-Athlete _____________________________________ Name of Parent/Legal Guardian (PRINT) (if student-athlete is under 18) ________________ Birthdate (mm/dd/yy) _________ Age ___________________ Date (mm/dd/yy) ___________________ Date (mm/dd/yy)

    _________________________________ Signature of Parent/Guardian

    Revised 05/2010

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