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W
a I v e r F o r m
__________________________________________________
University of South Alabama
Intramural, Club, and Recreational Sports
Waiver, Release, and
Indemnity Agreement
To be completed by all participants. If participant is
under 19 years of age, both participants and guardian must complete this
release. Participant and guardian must sign in the presence of two (2)
witnesses.
TO THE UNIVERSITY OF SOUTH ALABAMA:
Participant, _________________________,
and guardian understand that participant is enrolling in participating in All
USA Water Ski Club related Events from 1/13/03 – 5/24/03, which is
sponsored by the University of South Alabama. Particiapnt and guardian
understand that participation in this activity is voluntary and not
required by the University of South Alabama. Participant further
understands that he or she is participating at his/her own expense.
In consideration of the University of South Alabama
permitting the participant the opportunity to participate in this activity,
participant and guardian, in full recognition and appreciation of any and
all risks, hazards, or dangers inherent in this activity, including
transportation to and from related activities, to which participant may be
exposed, do hereby agree to assume all of the risks and responsibilities
surrounding participation in such activity.
Participant and guardian do
for themselves, their heirs and personal representatives, hereby defend,
hold harmless and indemnify, release forever discharge the University of
South Alabama, its trustees, officers, agents, servants and employees from
and against all claims, demands, and actions or causes of action on account
of or resulting from participation in this activity and which may result
from causes beyond the control of, or without the fault or negligence of
the University of South Alabama, its trustees, officers, agents, servants,
and employees, during the period of participation as aforesaid. Participant
and guardian understand that the University of South Alabama, its trustees,
officers, agents, servants, and employees assume and accept no liability
for personal injury or loss of life or damage to personal property
resulting from participants enrolling in the above-listed activity.
Participants and guardian
attest that participant is physically fit and has sufficiently trained for
participation in this activity, and that participant’s physical condition
has been verified by a licensed physician.
Participants and guardian
understand that participants in clubs at the University of South Alabama ARE
NOT covered by any NCAA or University health, or liability insurance.
Participant must obtain his/her own insurance coverage, and provide proof
thereof for participation in this club.
IN
WITNESS WHEREOF, participant and guardian have caused this release
to be signed this ____ day of ________________, 20__.
_______________________________ ______________________________
SIGNATURE OF PARTICIPANT
SIGNATURE OF WITNESS
_______________________________
______________________________
PRINTED NAME OF
PARTICIPANT
PRINTED NAME OF WITNESS
_______________________________
______________________________
SINGATURE OF GAURDIAN
SIGNATURE OF WITNESS
(if applicable)
_______________________________
______________________________
PRINTED NAME OF GAURDIAN
PRINTED NAME OF WITNESS
Telephone number of
guardian:
______________________________
Or
Name and telephone number of
next of kin:
______________________________
Submit
copy of waiver to bryanharris@dixielawncare.net
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