Required Medical Forms University Of Texas At Austin Page 3


The University of Texas at Austin
Department of Intercollegiate Athletics
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PARTICIPANT: ________________________________________________
CAMP: __________________________________
LOCATION: __________________________________________________
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


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