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Posted March 15th, 2011

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COLLEGIATE MEN'S DIVISION III CHAMPIONSHIP TOURNAMENT

WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK

 

In consideration of me being allowed to participate in any way in the Midwest Collegiate Men’s Division III Championship Tournament:

 

 

1.

I understand dangers may be caused by my own actions, or inaction’s, the actions or inaction’s of others participating in the Midwest Collegiate Men’s Division III Championship Tournament, I understand the nature of MIDWEST RUGBY FOOTBALL UNION events and acknowledge my experience and capabilities and believe I am qualified to participate in such MIDWEST RUGBY FOOTBALL UNION events. I further acknowledge that I am aware that the activity will be conducted in facilities open to the public during the event. I further agree and warrant that if, at any time, I believe conditions to be unsafe, I will immediately discontinue further participation in the event.

 

2.

I fully understand that: (a) MIDWEST RUGBY FOOTBALL UNION events involve risks and dangers of serious bodily injury, including permanent disability, paralysis, and death, (“Risks”); (b) these Risks may be present in the event or due to the negligence of the releasees named below; (c) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES incurred as a result of my participation in the event.

 

3.

I hereby release, discharge, covenant not to sue and agree to hold harmless MIDWEST RUGBY FOOTBALL UNION, their respective administrators, directors, agents, officers, volunteers, and employees, other participants, any sponsors, advertisers, and if applicable, owners and lessors of premises on which the event takes place (each considered one of the “Releasees” herein) from all liability, claims, demands, losses, or damages on account caused or alleged to be caused in whole or in part by the negligence of the “Releasees” or otherwise, including negligent rescue operations and further agree that if, despite this release, I, or anyone on my behalf makes a claim against any of the Releasees named above, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEY FEES, LOSS LIABILITY, DAMAGE OR COST ANY MAY INCUR AS THE RESULT OF ANY SUCH CLAIM.

 

4.

I AFFIRM THAT I HAVE A PERSONAL MEDICAL INSURANCE POLICY WITH LIMITS OF A MINIMUM OF $100,000.

 

 

 

YES

 

NO

 

 

 

 

 

 

I understand that I am ineligible to play and that I have an affirmative responsibility to withdraw from competition if said policy is not presently in good standing.

 

I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND IT’S TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY THE LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THAT THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT.

 

 

 

 

 

       

 

 

 

Print Name of Participant

 

Signature of Participant   Date      

Participant CIPP Number

 

 

 

           

 

 

 

Club Name

 

           

 

 

 

If Participant is less than 18 years of age a signature of a parent or legal guardian is required.

 

 

 

 

 

 

       

 

 

 

Print Name of Parent/Guardian

 

Signature of Parent/Guardian   Date      

 

 

 

PARTICIPANT MUST ACKNOWLEDGE SECTION #4 ABOVE