waiver for athletic tryout
WAIVER FOR ATHLETIC TRYOUT Each student who wishes to participate in an athletic tryout at USCB is required to complete the information and liability waiver as stated below. The waiver is valid for up to 7 days. Please read the form thoroughly before signing. Each participant must also attach: 1. Proof of Full-Time enrollment 2. A copy of your current, valid insurance card 3. A medical exam/physical completed by a MD, DO, PA, or NP within the last 12 months PART I: To be completed by the participant Name of sport:
Date for Tryout period to begin:
Participant’s Name (please print):
Participant’s Date of Birth:
Are you aware of any preexisting medical conditions that would cause potential medical risk during participation in the sport for which you are trying out? Yes No Do you recognize and accept the risks that are associated with the sport for which you are trying out and any medical complications that could arise due to the involvement of bodily contact, physical stress and potential injury? Yes No Do you authorize the sports medicine staff, team physicians, and coaching staff of USCB to provide or secure any and all emergency medical treatment which may be deemed necessary? Yes No Do you certify that you have primary insurance for medical coverage and release USCB and its athletic department of any financial obligation for any medical bills incurred as a result of injury during this tryout period? Yes No Do you understand that you are not entitled to any facilities or services of the athletic training room during this period except for emergency care? Yes No In consideration of participating in a tryout for USC Beaufort athletics, I, ________________________________, in full recognition and appreciation of the dangers and risks inherent in such activities, do hereby waive, release and forever discharge USC Beaufort, its members and the University of South Carolina, its affiliated entities, its officers, agents and employees, from and against any and all claims, demands, actions, or causes of action, for costs, expenses, or damages to personal property, or personal injury, o r illnesses, paralysis, or death, which may result from my participation in the aforesaid activities. I acknowledge that my participation in the above described activities is voluntary. I also understand and acknowledge that the aforesaid activities may be hazardous, that my participation is solely at my own risk, and that I voluntarily assume full res ponsibility for any resulting loss of property, illness, injuries, paralysis, or damages including death. I recognize that this Waiver of Liability and Release means that I am giving up, a mong other things, right to sue the University of South Carolina Beaufort, its members and the University of South Carolina, its affiliated entities, its officers, agents and employees for injuries, damages or losses I may incur as a result of my participation in the aforesaid activities. I also understand that this Waiver of Liability and Release binds my heirs, executors, personal relatives, attorney -of-law, attorneys-in-fact, administrators and assigns, as well as myself. I further agree to indemnify and hold the University of South Carolina Beaufort, its members and the University of South Carolina, its affiliated entities, its officers, agents and employees harmless from any loss, liability, damage or cost including court costs and attorney’s fees incurred as a result of my participation in these activities. The Waiver of Liability and Release shall be governed by and construed under the laws of the state of South Carolina. I acknowledge and represent that I have carefully read this document and that I understand it, sign freely and voluntarily, and agree to be legally bound by it. Participant Signature:
Date:
Parent Signature (if under 18):
Date:
PART II: To be completed by the athletic training and coaching staff members The above named participant has submitted all necessary documents and paperwork and is eligible to engage in the athletic tryout beginning on the specified date above and ending no later than 7 days from that date. Signature of athletic trainer:
Date:
Signature of head coach:
Date:
Date for Tryout period to begin:
Participant’s Name (please print):
Participant’s Date of Birth:
Are you aware of any preexisting medical conditions that would cause potential medical risk during participation in the sport for which you are trying out? Yes No Do you recognize and accept the risks that are associated with the sport for which you are trying out and any medical complications that could arise due to the involvement of bodily contact, physical stress and potential injury? Yes No Do you authorize the sports medicine staff, team physicians, and coaching staff of USCB to provide or secure any and all emergency medical treatment which may be deemed necessary? Yes No Do you certify that you have primary insurance for medical coverage and release USCB and its athletic department of any financial obligation for any medical bills incurred as a result of injury during this tryout period? Yes No Do you understand that you are not entitled to any facilities or services of the athletic training room during this period except for emergency care? Yes No In consideration of participating in a tryout for USC Beaufort athletics, I, ________________________________, in full recognition and appreciation of the dangers and risks inherent in such activities, do hereby waive, release and forever discharge USC Beaufort, its members and the University of South Carolina, its affiliated entities, its officers, agents and employees, from and against any and all claims, demands, actions, or causes of action, for costs, expenses, or damages to personal property, or personal injury, o r illnesses, paralysis, or death, which may result from my participation in the aforesaid activities. I acknowledge that my participation in the above described activities is voluntary. I also understand and acknowledge that the aforesaid activities may be hazardous, that my participation is solely at my own risk, and that I voluntarily assume full res ponsibility for any resulting loss of property, illness, injuries, paralysis, or damages including death. I recognize that this Waiver of Liability and Release means that I am giving up, a mong other things, right to sue the University of South Carolina Beaufort, its members and the University of South Carolina, its affiliated entities, its officers, agents and employees for injuries, damages or losses I may incur as a result of my participation in the aforesaid activities. I also understand that this Waiver of Liability and Release binds my heirs, executors, personal relatives, attorney -of-law, attorneys-in-fact, administrators and assigns, as well as myself. I further agree to indemnify and hold the University of South Carolina Beaufort, its members and the University of South Carolina, its affiliated entities, its officers, agents and employees harmless from any loss, liability, damage or cost including court costs and attorney’s fees incurred as a result of my participation in these activities. The Waiver of Liability and Release shall be governed by and construed under the laws of the state of South Carolina. I acknowledge and represent that I have carefully read this document and that I understand it, sign freely and voluntarily, and agree to be legally bound by it. Participant Signature:
Date:
Parent Signature (if under 18):
Date:
PART II: To be completed by the athletic training and coaching staff members The above named participant has submitted all necessary documents and paperwork and is eligible to engage in the athletic tryout beginning on the specified date above and ending no later than 7 days from that date. Signature of athletic trainer:
Date:
Signature of head coach:
Date:
