Holy Family University Prospect Clinic

Holy Family University

Assumption of Risk Waiver

for Use of Athletic Facilities

Name of Participant:___________________________________                 Participant’s Age:                

Name of Parent/or Guardian if under 18 (please circle one) _________________________         

Reason for Request:    ______Baseball Clinic_                                                                      

An individual must understand there are certain risks with physical activity.  The University staff will provide emergency medical care through its emergency medical plan.  Any further medical or therapeutic care must be arranged through the above named individual’s personal medical insurance carrier’s network.

Holy Family University carries no medical insurance for non-Holy Family University students or personnel, nor accepts financial responsibility for any injury sustained while using Holy Family University’s athletic facilities and participating in physical activity.

I_____________________________ accept that                                            will be participating

               ^{Please Print – Parent/Guardian-circle one                                            Please Print—Name of Participant}

In athletic activity, and that athletic activity requires an acceptance of risk of injury.  I understand there is a possibility that a catastrophic injury may occur.  Participation in any physical activity could result in death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to all internal organs, serious injury to all bones, joints, ligaments, muscles, tendons and other aspects of the musculoskeletal system, and serious injury or impairment to other aspects of my body, general health and well-being.

I accept that Holy Family University is not responsible for any previous/current medical conditions that                                     may have or for any
Please print-name of participant
medical expenses incurred due to any pre-existing medical conditions, or those incurred during usage of Holy Family University’s athletic facilities while participating in any physical activity.

I hereby forever release and discharge Holy Family University, it’s officers, directors, employees, agents, staff, volunteers and any person or organization affiliated with Holy Family University from any and all claims, actions and demands arising out of or in conjunction with injuries resulting from usage of HFU’s athletic fields while participating in any physical activity.

Signature of Participant or Parent/Guardian if under 18
                                                Date:              (please circle one)