Release and Waiver
2009
“34th National Collegiate Taekwondo Championship”
The following document should be read carefully. It must be signed and brought to Brown University
and turned in at the time of your check in, prior to your participation in the 34th National Collegiate
Taekwondo Championship.
Release executed on ___________________, 2009 by ________________________________ (print your
full name) of (your
address) for the benefit of Brown University (hereinafter referred to as “Brown”).
I the undersigned will be a participant in the 34th National Collegiate Taekwondo Championship
(hereinafter referred to as the “Championship”) which is being hosted by the Brown University
Taekwondo Club and being held at the Paul Bailey Pizzitola Memorial Center on Brown’s campus from
March 21, 2009 through March 22, 2009. I acknowledge that I am voluntarily participating in the
Championship, and I further understand that my participation is subject to any and all rules and/or
procedures outlined for me by persons conducting, leading, and/or directing the Championships.
I acknowledge that participation in the Championship presents risks both minor and serious, including but
not limited to broken bones, brain damage, paralysis, and even death. Further, I acknowledge that I am
aware of and voluntarily agree to assume all such risks for any and all bodily injury and/or loss to my
personal property, resulting from my participation in the Championship. I also acknowledge that I am
physically capable of participating in the Championship and have no known health restrictions that might
jeopardized my safety and/or health and that I am responsible for monitoring my condition and will
refrain from, and cease participation in the Championship if I believe continued participation poses a risk
to my health or to the health of a fellow participant.
I further authorize and empower any person acting in a supervisory capacity for the Championship, in the
event of an emergency; to provide medical aid to me if the need so arises. If such and event occurs I agree
to pay for any and all cost and expenses so incurred in the exercise of such discretion.
In consideration of my being permitted to participate in the Championship on the campus of Brown
University, I do hereby release, indemnify, and forever discharge Brown University, including the
Corporation, its Trustees, faculty, employees, staff, and other agents and members of the Brown
University Taekwondo Club from and against any and all liability and responsibility for any claim or
cause of action on account of any personal injury, accident, damage, expenses, or other loss caused,
suffered, or incurred by myself or any other person(s) or entity during, arising out of or in any way
associated, directly or indirectly, with my participation in the Championship and presence on the campus
of Brown University and from contribution or indemnification in respect to any claim made against me by
any other participant in the Championship or any other person or entity in connection therewith.
Further, I acknowledge that I have read and understand the above statements and that if I am unable to do
so, for whatever reason, I have had them read to me and am confident that the individual so doing has
read and/or translated the statements truthfully and in their entirety. I also acknowledge that I am at least
eighteen (18) years old and of legal age to bind myself to this release and waiver, but if I am not at least
eighteen (18) years of age, I have also submitted written approval and consent of my parents(s) and/or
legal guardians(s).
OGC: 09/036/RW
34th Annual Taekwondo Championship
02/05/09
Page 1 of 2
This release and waiver has been executed on behalf of myself, my heirs and assigns, and has been made
with full knowledge of possible risks involved. This instrument has been executed in and shall be
interpreted according to the laws of the State of Rhode Island.
___________________________________ ___________________________________
(Witness) (Signature)
Printed Name: Printed Name:
Date: Date:
SIGNATURE OF PARENT(S) OR GUARDIAN(S) REQUIRED IF UNDER THE AGE OF 18.
Signature of Parent(s)/Guardian(s) Witness
Date: Date:
Signature of Parent(s)/Guardian(s) Witness
Date: Date:
OGC: 09/036/RW
34th Annual Taekwondo Championship
02/05/09
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