This form is required for any non-Vanderbilt student-athlete participating in activities in any university athletics venues.
NAME (last, first, MI)AFFILIATION WITH VANDERBILT
_____ RECRUIT
_____ FORMER VU STUDENT-ATHLETE
_____ OTHER (Please explain)
CELL PHONE NUMBER
EMERGENCY CONTACT PERSON & PHONE NUMBER:
HOME ADDRESS (street, city, state, zip)
DATES ON CAMPUS
TO PARTICIPATE YOU MUST READ AND SIGN THE RELEASE OF LIABILITY ON THE FOLLOWING PAGE
Process:
- Coaches are responsible for ensuring this form has been completed by any visiting athlete BEFORE they participate in any athletic activity.
- Completed forms should be submitted to the AD’s office in a timely manner.
- The AD’s office will maintain a copy of all forms and post a listing of participants who have completed the form on the department shared drive in the Staff Resources folder.
RELEASE OF LIABILITY
IMPORTANT! THIS FORM MUST BE COMPLETED FOR PARTICIPATION
SPORTING EVENT / FACILITY: ______
The Vanderbilt University Student Athletics department (hereinafter “Vanderbilt”), allows visiting athletes to workout in practices and/or pick-up games with its athletic teams (hereinafter “activity”). I, the undersigned, desire to voluntarily participate in the activity. I acknowledge that I am in good health and in proper physical condition to participate in the activity. I also acknowledge that I have been fully informed of the nature of the activity and understand that I must wear the proper protective sporting gear required for the activity. I understand that Vanderbilt does not guarantee my safety during participation in the activity and that there are inherent risks of personal injury or property damage, (including death), to myself and to others which are associated with the activity. Notwithstanding the inherent risks, I wish to assume them by voluntarily participating in this activity. I understand and agree that Vanderbilt, its students, volunteers, and staff (collectively referred to as “Parties”) accepts no responsibility for my acts or the acts of others while I am participating in this activity.
In consideration of Vanderbilt offering this opportunity and allowing me to participate in this activity, I do agree to and hereby do forever release from fault, discharge and hold harmless and indemnify the Parties and its officers, trustees, agents, servants, employees, and representatives against loss (including reasonable attorneys’ fees), from any and all claims, demands, rights, or causes of action of any kind or nature that may hereafter at any time be made or brought by me, or by any other person having a legal interest therein, arising from or by reason of any and all known or unknown, foreseen and unforeseen bodily or personal injuries, damages to property and consequences thereof which may be sustained by me in consequence of any accident or injuries in connection with the Activity, except such liability or claim of liability as may result from the gross negligence on the part of the Parties. Furthermore, I agree to indemnify Vanderbilt for any loss or damage to the premises, facility, or equipment of Vanderbilt caused by me.
I agree to use standard precautions at all times during the Activity. If I should suffer any other injury or illness while participating in the Activity, I authorize the employees of Vanderbilt to use their discretion to treat me at Vanderbilt University Medical Center or have me transported to any medical facility I choose for treatment ______and I take full responsibility for that action.
[Name of Facility if other than VUMC]
I further grant and convey unto Vanderbilt all right, title and interest in any and to all photographic images and video or audio recordings and all copies thereto made by Vanderbilt during my participation in the Activity, including but not limited to, any royalties, proceeds or other benefits derived from such photographs or records.
READ BEFORE SIGNING
By signing below, I acknowledge that I am 18 years of age or older and understand that I am entitled to have an attorney of my own choosing to review the release prior to signing, I have read the foregoing Release in its entirety and understand that I am signing a complete and perpetual release and bar to any and all claims of ordinary negligence as defined above resulting from my participation in this activity.
Print and Sign______Date:______
Parent or Guardian:______Date:______
(if Participant is under the age of 18)