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    Low Ropes Waiver04.12.11

    Uploaded by

    kesetze
    This document is a waiver form for participation in a low ropes teambuilding course. It contains: 1) A section for the participant to provide their contact information and emergency contact. 2) A waiver of liability where the participant agrees to hold harmless the university for any injuries or claims resulting from participation. It lists some risks like falls or injury. 3) The participant acknowledges understanding the risks and agrees to the waiver. They also allow use of photos/videos from the activity. The form must be signed by the participant and for minors, their parent/guardian as well. Any medical conditions are to be noted on the back.

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    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd

    Low Ropes Waiver04.12.11

    Uploaded by

    kesetze
    57 views1 page
    This document is a waiver form for participation in a low ropes teambuilding course. It contains: 1) A section for the participant to provide their contact information and emergency contact. 2) A waiver of liability where the participant agrees to hold harmless the university for any injuries or claims resulting from participation. It lists some risks like falls or injury. 3) The participant acknowledges understanding the risks and agrees to the waiver. They also allow use of photos/videos from the activity. The form must be signed by the participant and for minors, their parent/guardian as well. Any medical conditions are to be noted on the back.

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    © Attribution Non-Commercial (BY-NC)

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    This document is a waiver form for participation in a low ropes teambuilding course. It contains: 1) A section for the participant to provide their contact information and emergency contact. 2) A waiver of liability where the participant agrees to hold harmless the university for any injuries or claims resulting from participation. It lists some risks like falls or injury. 3) The participant acknowledges understanding the risks and agrees to the waiver. They also allow use of photos/videos from the activity. The form must be signed by the participant and for minors, their parent/guardian as well. Any medical conditions are to be noted on the back.

    Copyright:

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

    Low Ropes Waiver04.12.11

    Uploaded by

    kesetze
    This document is a waiver form for participation in a low ropes teambuilding course. It contains: 1) A section for the participant to provide their contact information and emergency contact. 2) A waiver of liability where the participant agrees to hold harmless the university for any injuries or claims resulting from participation. It lists some risks like falls or injury. 3) The participant acknowledges understanding the risks and agrees to the waiver. They also allow use of photos/videos from the activity. The form must be signed by the participant and for minors, their parent/guardian as well. Any medical conditions are to be noted on the back.

    Copyright:

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

    Teambuilding- Low Ropes

    PLEASE PRINT:
    Participant’s Name:________________________________________________________ Gender ________

    Address:_____________________________________________________________________________________________
    (Street) (City) (State) (Zip)

    Phone: (home) (work)____________________________________ UID#:____________________________________

    Check One: Student _________ Faculty/Staff ________ Public_______ E-Mail:______________________________


    Minors (under the age of 18) must have their parent/guardian sign this form in order to participate.

    WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT


    The undersigned wishes to participate in the Outdoor Adventure Program Low Ropes Course sponsored by the Campus
    Recreation Department of Illinois State University (“ISU”). In consideration for the privilege of participating in this program, the
    undersigned agrees to the following clauses.

    1) The undersigned certifies that he/she is capable of participating in the Outdoor Adventure Program Low Ropes
    Course. ISU reserves the right to deny anyone the opportunity to participate in the program.

    2) The undersigned acknowledges and understands that participation in activities in the outdoors may involve above
    normal risk and has hereby been made aware that participation in the Low Ropes Course has the following non-
    exhaustive list of particular risks involved in the challenge course: falls, falling branches or equipment, sprains/strains,
    inclement weather or death.

    3) The undersigned hereby agrees to indemnify and hold harmless the Board of Trustees of Illinois State University, its
    officers, employees, agents, and assigns from any and all claims, actions, suits, procedures, costs, expenses,
    damages and liabilities, including attorney’s fees, brought as a result of my involvement in the Low Ropes Course.

    4) I have read this waiver of liability, assumption of risk, and indemnity agreement, fully understand its terms, and
    understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the
    agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability
    to the greatest extent allowed by law.

    5) I hereby agree to allow the Campus Recreation Department of the Board of Trustees of Illinois State University, and
    persons acting for or through them the right to use, reproduce, assign, and/or distribute photographs, films,
    videotapes, and sound recordings of myself, for use in materials they may create.

    NAME OF CONTACT PERSON IN CASE OF EMERGENCY:

    Name: ________________________________________ Complete Address:_________________________________________________


    (street)

    Phone: (Primary) (Secondary)


    (city) (state) (zip)

    Medical Insurance Carrier:________________________________________ Policy #__________________________________________

    I do not have medical insurance or can not provide the information


    but intend to participate and will pay my expenses if injured: ____________________________________________________________
    (signed)

    SIGNATURE _____________________________________________ DATE _____________________


    (participant)

    PRINTED NAME____________________________________________

    Parent/Guardian signature of minor ______________________________________________________

    **Please write any medical condition that may affect your challenge course experience such as pregnancy, recent surgeries or injuries on
    the back of this form**

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