REBEL SOFTBALL CAMPS ASSUMPTION OF RISK LIABILITY FORM

REBEL SOFTBALL CAMPS
ASSUMPTION OF RISK LIABILITY FORM
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I,____________________________________ (Participant), in consideration for my participation in the specified
activity indicated below, sponsored by the University of Nevada, Las Vegas (UNLV) Department of
Intercollegiate Athletics (UNLV), on behalf of myself, my assigns, and my heirs, expressly and knowingly agree
to hold harmless, indemnify and defend the Nevada System of Higher Education (NSHE), on behalf of
University of Nevada, Las Vegas Intercollegiate Athletics from any and all suits, claims, demands,
damages, liability, costs and expenses, including attorney fees, arising from any alleged gross negligence or
intentional misconduct of myself in the performance of executing this waiver due to the risks associated
with the activity in which I am participating in or travel to and from the activity, and any and all suits,
claims, demands, damages, liability costs, and expenses, including attorney’s fees that I may incur, may
have had or may have in the future regarding any pre-existing conditions that I may have had prior to the
effective date of this Release of Liability Form, except such suits, claims or demands in which I seek to
compel UNLV to comply with its obligations.
In addition, I understand and agree that the UNLV cannot be expected to control all of the risks associated with
the indicated activities, and may need to respond to accidents and other emergency situations. Therefore, I hereby
give my consent to the administration of any medical treatment that may deemed by UNLV to be required by
me relative to my participation, with the understanding that the costs of such treatment will be my
responsibility, unless otherwise provided below. I acknowledge that the UNLV does not carry medical or any
other insurance for participants in the activities named, unless the participants are informed otherwise in writing.
Therefore, participants must provide their own medical, disability or other appropriate insurance.
The Assumption of Risk/Release of Liability and Consent to Emergency Treatment contains the entire agreement
between the parties, and supercedes any prior written or oral agreements between them concerning the specific
activity described in the paragraph initialed below. The provisions of this waiver will continue in effect even after
the conclusion of said activities, whether said conclusion is by agreement, operation of law, or otherwise.
IMPORTANT: Always consult your physician before beginning any exercise program. This
general information is not intended to diagnose any medical condition or to replace your
healthcare professional. Consult with your healthcare professional to design an appropriate
exercise prescription. If you experience any pain or difficulty with these activities, stop and consult
your healthcare provider.
I have read the foregoing agreement and have knowingly and willingly signed it with a full understanding of its
purpose. I acknowledge that the activity specified involves strenuous activity, and that I know of no medical
reason why I should not participate. I affirmatively represent that I am otherwise competent to execute this
agreement, intend to be bound by it, and agree that it shall be governed by the laws of the State of Nevada.
Print Name _______________________________
Date of Birth______________________________ Phone # ______________________________
Local Address ___________________________________________________________________
E-mail Address __________________________________________________________________
__________________________________________
Participant Signature
________________________________________
Date
UNDER 18 YEARS OF AGE:
I expressly represent that I am a parent or legal guardian of the Participant, that I am legally authorized
and entitled to execute this agreement on my behalf and that of the Participant, that I have read the
foregoing agreement and have signed on behalf of Participant and myself with a full understanding of its
purpose. I acknowledge that the activity specified involves strenuous activity, and I know of no medical
reason why Participant should not participate. I affirmatively represent that I am competent to execute
this agreement, that Participant and I intend to be bound by it, and agree that it shall be governed by the
laws of the State of Nevada.
_______________________________________
Parent / Guardian Signature
_____________________________________
Date
EMERGENCY NOTIFICATION INFORMATION
Participant Name___________________________________________
Date of Birth_________________________________________
Emergency Contact’s Number________________________________________________
Phone #______________________________________________
Address________________________________________________________________________
City________________________________
State________
Zip________________
Please list any medical services required, existing medical conditions, or allergies:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________