Travel And Trip Risk Acknowledgement Liability Waiver Form (Page 3 of 3) in pdf

RECREATIONAL OR SPECIAL RISK ACTIVITIES

RISKS AND PRECAUTIONS

Trip Leaders: Please check ALL that apply to this Trip/Function:

CONTACT SPORTS (Football(any type), Soccer, Lacrosse, Boxing, Wrestling)

NON-CONTACT SPORTS (sports not included in above)

Please List All that Apply:

RECREATIONAL ACTIVITIES (NOT-Water related) - Please Circle ALL that Apply:

Theme Park Activities, Carnival/Fair Rides, Inflatable Rides/activities, Camping, Hiking, Zip-lining, Horseback riding, Ropes

course, Archery, Climbing wall, Skeet shooting/gun range, Fencing, Bowling, Badminton, Wall Propelling, ATV or Go-cart

riding, Mini-Golf Park activities, Petting Zoo/Animal interaction, Theatre/Performance activities. Other (Please Explain):

RECREATIONAL WATER-RELATED ACTIVITIES – Please Circle ALL that Apply:

Swimming, Snorkeling/Diving, Canoeing/Kayaking, Fishing, Surfing, Beach activities, Wind surfing, Sailing, White-Water

Rafting. Other: (Please Explain):

VOLUNTEER/SERVICE-PROVIDING ACTIVITIES: (Please circle ALL that apply):

Gardening/farm/crop activities, Assistance with Building Projects, Computer projects, Tutoring/mentoring,

Other: (please explain):

Other Special Risk Activities: Please Describe:

Possible Risks or Injuries included in the above activities may include, but are not limited to:

Risk of injury inherent in playing any type of sports or recreational activities; Exposure to outdoors, nature, weather, Acts of

God, sea life, insects/animal or plant life; Inexperience or unfamiliarity with the activity or its requirements; Unfamiliarity with

location or facility; Faulty equipment/gear or inadequate instruction, Violence/criminal acts of others; Complications or reaction

from weather conditions or outside environment or Nature; Inadequate or unavailable healthcare facilities or assistance;

Accidents; Illnesses; Allergic Reactions(food, plants, insects etc); Negligence; and/or Mistake.

I understand and acknowledge that these risks may result in personal injury, including but not limited to the following:

Collision with: other players/participants, sports/recreational equipment, structures, vehicles, swimmers, vessels or surfers;

Slips/trips/falls; falls from heights, fractures/broken bones; sprains/strains; bruises; lacerations; punctures; concussion; loss of

consciousness; physical exhaustion/heat exhaustion; hypothermia, eye injuries; sunburn/windburn/camping burns; drowning;

diving/boating accidents; bites/stings/burns/rashes from contact with animals/insects or sea life; sun poisoning or stroke; injuries

from shark attack; spinal injuries; paralysis; brain damage; serious injury to internal organs, bones, ligaments, joints, muscles,

tendons, and other aspects of the muscular skeletal system; neck, face and head injuries; ear injuries, heart attack; sickness;

and/or death as a result of the nature of some related activities. Possible loss or damage to personal property; Etc.

Recommended Precautions :

Check local weather before departure and become familiar with recreational activities you plan to do

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Bring appropriate clothing, footwear, supplies, protective gear (sports related, sunglasses, sunscreen, hat, etc) suitable

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for destination weather, outdoor or recreational activities, standing/walking etc.

Avoid bringing valuables or keep secure at all times. Stetson University is not responsible for lost or stolen items.

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Bring any necessary medications or emergency/medical kits (ie bee sting kits/epi-pen, inhalers, etc)

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Know how to reach your trip leader in event of an emergency or issue

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Note Stetson Public Safety 24 Hour Hotline in your Cell Phone: 386-822-7300

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Travel And Trip Risk Acknowledgement Liability Waiver Form Page 3

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