Required Medical Forms University Of Texas At Austin (Page 3 of 4) in pdf

The University of Texas at Austin

Department of Intercollegiate Athletics

REQUIRED ME DICAL FORMS

3 / 4

THE UNIVERSITY OF TEXAS AT AUSTIN * SPORTS CAMPS

ASSUMPTION OF RISK/RELEASE AND INDEMNIFICATION AGREEMENT

PARTICIPANT: ________________________________________________

CAMP: __________________________________

LOCATION: __________________________________________________

DATE(S):_________________________________

I am the parent/Guardian of the above-named Participant and am fully competent to sign this Agreement.

I realize that my child’s participation in camp activities carries with it risk of injury/illness, even when all

rules are followed and conditions are optimal. There are various safety problems that can increase injury

risk potential. Some safety problems are regularly identified and addressed (i.e., heat illness and the

administration of liquids frequently during practices; collisions and the use of high quality, durable, and safe

protective equipment). Some safety problems may be less clearly identified (i.e., mechanisms of head and

neck injuries or ankle and knee injuries,) and, therefore, prevention and protection are difficult. Risk can

be increased due to the participant’s lack of compliance with specified instructions (i.e., using improper

footwear, knowingly using dangerous of faulty equipment, training when environmental conditions are

dangerous (high heat/high humidity, lighting), and engaging in high intensity or high volume training or

executing new skills without adequate fitness. Even in the best facilities, with adequate supervision, use of

all protective equipment, and compliance with all of the rules, there remains an inherent risk of

injury/illness in any camp activity, and this risk is increased even more so with contact sports.

I acknowledge that my child’s voluntary participation in this camp may expose him/her to hazards of risks

that may result in his/her illness, personal injury, or death. I acknowledge that I am aware of the risks of

injury/illness and knowledgeable concerning rules, equipment and practices being employed by UT camp

personnel to minimize my child’s risk of sustaining an injury/illness while participating in camp activities.

My child agrees to use all required protective equipment and follow all rules and instructions from

University officials regarding safety. Also, my child has no known physical infirmities which could be

worsened or aggravated by participation and I declare him/her physically fit and in good medical condition

to engage in all camp activities.

In consideration of my child being permitted to participate in the camp and to use the program’s facilities

and equipment, I hereby accept all risk to my child’s health and of his/her injury or death that may result

from such participation. I hereby release The University of Texas at Austin, its Board of Regents, officers,

employees, and representatives from any and all liability in any way resulting or arising from any injuries

(including death), damage, loss or costs that may incur as a result of my child’s participation in the camp. I

intend this release to be binding upon my heirs, executors, administrators and assigns. I further agree to

indemnify and hold harmless the Institution person(s) and damage to property that may result from

Participant’s negligent or intentional act or omission while participating in the described Activity.

I have carefully read this agreement and I understand that it is legally binding document that affects my

child’s legal rights and remedies.

____________________________________________

______________

________________________________

Signature of Parent/Guardian

Date Signed

Address (if different than Participant’s)

Apvd. by UT Austin Legal, JG, 02/08/2010

Required Medical Forms University Of Texas At Austin Page 3

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