Informed Consent and Travel Agreement - UREC Sports Clubs by pptfiles


									                                                    UREC Sports Clubs Participation Statement
                                                      Informed Consent/Travel Agreement
Each participant of all res pecti ve Sport Cl ubs must read, complete, and sign the followi ng form before any and all invol vement in
acti vi ties related to their s port club, this includes tryouts. Form must be updated yearly and kept on file in the Student Leadership
Office, 3 rd floor, UREC.

I, _________________________________________, as a current or potential member of the James M adison University
____________________________________ Club, affirm that I have no medical, physical or mental health conditions which would hinder or prevent my active
participation in the referenced activity, and that I am voluntarily participating as a member of the aforementioned club. I a m aware that such participation
involves a risk of injury, which may include severe injuries, potentially involving paralysis, permanent mental disability, or death, and that I am assuming any
risk that may be involved with participation in this sport.

I hereby release and promise not to sue the Commonwealth of Virginia, James M adison University, its agents or employees, from and for any injury (including
sickness or death) to me, or damage or loss to my property, arising out of my participation in this program, no matter the cause. I understand that the only
exception to the preceding term would be if injury, loss or damage is due to intentional misconduct on the part of an employee or agent of the Commonwealth of

I also understand that I am financially accountable for all Sport Club equipment that I utilize or that which is placed in my care. I understand and agree to adhere
to UREC Sport Club policies and procedures, and will represent that Club and University Recreation (UREC) accordingly.

I understand that coaching is not provided by James M adison University, but by the club – this individual may be an undergraduate student. I waive the right to
recover damages for injury from the university as a result of actions, inaction, omission and/or negligence of a coach.

                                           SPORT CLUBS PARTICIPANT TRAVEL AGREEMENT
I, a member of the James M adison University _______________ Club in order to fully participate in all activities associated w ith the club agree to abide by the
following statements. These guidelines were established to ensure that I behave in an appropriate and respectful manner as a student as well as a member of an
organization sponsored by James M adison University, University Recreation Department and the Sports Club Council.

1.   I will uphold the JM U Honor Code.

2.   I will abide by all local and state laws.

3.   I will follow the policies and procedures set forth by UREC, James M adison University, the National Intramural-Recreational Sports Association and the
     national governing bodies of my club.

4.   I will abide by the rules and guidelines set forth by the University with whom we are competing or by the tournament in which we are participating.

5.   I will behave in a sportsman-like manner in all competitive or non-competitive events.

6.   I will abide by the rules, regulations and requests of the hotel in which we are staying.

7.   I will not participate in any activity that would deem harmful or destructive to any persons or private property. I understand that I am responsible for any
     damage to property. This includes, but is not limited to, all modes of transportation, hotels, tournament sites, recreation centers and club or university sports

I have read and understand all of the above statements; policies set forth and agree to follow each. I also understand that if I fail to follow these guidelines I will
accept full responsibility for myself and the consequences that will be imposed on me and my club members.

PRINTED NAME: ___________________________________________________________________

JAC CARD NUMBER: _______________________________________________________

BIRTH DATE: ______________________________________________________________________

S IGNATURE: ___________________________________________ DATE: ____________________

EMERGENCY CONTACT NAME & PHONE #: _________________________________________

If a sports club member is under the age of 18, his/her parent of guardian must sign below consenting participation based o n the aforementioned
statements of responsibility.

PARENT/GUARDIAN PRINTED NAME: ________________________________________________

PARENT/GUARDIAN S IGNATURE: ____________________________________________________

PARENT/GUARDIAN PHONE N UMBER: _________________________ DATE ______________

S PORT CLUB COORDINATOR APPROVAL S IGNATURE: ________________________________

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