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1 1 ~ t ~ ~ E ~ 0 , ~ 1 x t t ~ t t t t t ~ t t t t t t t t t t t t t t t t : RELEASE AND WAIVER OF LIABILITY
FOR VISITING TEAMS
Name of Team ____________________________ Institutional Affiliation _____________________________
Team Captain ____________________________
Phone Number _________________ Email Address __________________________
Date(s) of Participation __________________________________________________________________________
Is your team covered under a group/institutional liability insurance policy? ____ yes ____ no
Insurance Company __________________________________ Amount of Coverage ________________________
The undersigned hereby agrees that in consideration of MTSU Sport Club Program allowing the undersigned to use the MTSU Sport Club Complex facilities and/or to participate in the MTSU Sport Club competition, he/she does for himself/herself and his/her heirs, executors, administrators and assigns hereby release, waive, and forever discharge MTSU Sport Club Program and/or ֲý (herein after referred to as Releases), from any and all liability, claims, demands, actions, or causes of actions arising out of or related to any injury or illness, including death, that may be sustained by the undersigned, or to any loss or damage to property belonging to the undersigned, whether caused by the negligence of Releases, or otherwise, while using the Sport Clubs Complex facilities and/or participating in this program.
The undersigned further hereby agrees to indemnify and hold harmless the Releases from any personal injury or illness, loss or damage to property, or costs, including court costs and attorneys fees, that he/she may incur while using the MTSU Sport Club Complex facilities and/or participating in the MTSU Sport Club competition.
The undersigned verifies that to the best of his/her knowledge he/she has no physical condition which would interfere with his/her ability to participate in this program or would endanger himself/herself or other participants.
The undersigned hereby certifies that he/she is covered under personal accident/medical insurance, and the undersigned hereby acknowledges that he/she is solely responsible for any medical or other costs arising out of any bodily injury, illness, or property damage sustained by him/her as a result of or arising out of his/her use of the MTSU Sport Club Complex facilities and/or participation in the MTSU Sport Club competition.
Participants:
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Name (print) Signature
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