TAMUS-OGC-Approved 06/2007 - RISK WAIVER FORM
Account Number Date (04/14/2018)
Enter Student Organization Name and Event Here: One Army Gladiator DashÂ
STUDENT ORGANIZATION WAIVER, INDEMNIFICATION, AND MEDICAL
TREATMENT AUTHORIZATION FORM
1. EXCULPATORY CLAUSE. In consideration for receiving permission to participate in
any and all activities of _Gladiator Dash__ (herein referred to as â€œactivityâ€),
which is sponsored by _One Army______, a Recognized Student
Organization, (herein referred to as â€œorganizationâ€), I hereby release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes organization, The Texas A&M University System, the Board of Regents for The Texas A&M University System, Texas A&M University, and their members, officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES or INDEMNITEES) from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorneyâ€™s fees and expenses, that may be sustained by me while participating in such activity, while traveling to and from the activity, or while on the premises owned or leased by RELEASEES, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct.
2. INDEMNITY CLAUSE. I am fully aware that there are inherent risks to myself and
others involved with this activity, including but not limited to
_running, climbing, swimming, sliding, and jumping over obstacles___, and I choose to voluntarily participate in said activity with full knowledge that the activity may be hazardous to me and my property, and to the person and property of others. I acknowledge there may be physically strenuous activities. I know of no medical reason why I should not participate. I agree to indemnify and hold harmless INDEMNITEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorneyâ€™s fees and expenses, which may occur to myself, other participants, and third-persons as a result of my participation in said activity, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of INDEMNITEES.
3. NO INSURANCE. I understand that RELEASEES may or may not maintain any
insurance policy covering any circumstance arising from my participation in this activity or any event related to that participation. As such, I am aware that I should review my personal
insurance coverage. Organization may not carry general liability insurance to cover claims
arising from this activity so it seeks a waiver of claims as additional consideration for the right to participate so organization, can (a) provide the activity at the lowest possible cost to participants; and (b) provide access to a greater number of participants by expending limited resources on program materials rather than on liability insurance.
4. BINDS HEIRS. It is my express intent that this agreement shall bind the members of
my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be governed by the laws of the State of Texas.
5. MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, andÂ WAIVER. I understand RELEASEES cannot be expected to control all of the risks articulated inÂ this form and RELEASEES may need to respond to accidents and potential emergencyÂ situations. Therefore, I hereby give my consent for any medical treatment that may be required,Â as determined by a medical professional at the medical facility, during my participation in thisÂ activity with the understanding that the cost of any such treatment will be my responsibility. IÂ TAMUS-OGC-Approved 06/2007Â agree to indemnify and hold harmless INDEMNITEES for any costs incurred to treat me, even ifÂ an INDEMNITEE has signed hospital documentation promising to pay for the treatment due to myÂ inability to sign the documentation. I further agree to release, waive, discharge, covenant not toÂ sue, and agree to hold harmless for any and all purposes, RELEASEES from any and allÂ liabilities, claims, demands, injuries (including death), or damages, including court costs andÂ attorneyâ€™s fees and expenses, that may be sustained by me while receiving medical care or inÂ deciding to seek medical care, including while traveling to and from a medical care facility,Â including injuries sustained as a result of the sole, joint, or concurrent negligence,Â negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiverÂ does not apply to injuries caused by intentional or grossly negligent conduct.Â
6. VOLUNTARY SIGNATURE. In signing this agreement I acknowledge and represent
that I have read it, understand it, and sign it voluntarily as my own free act and deed; organization has not made and I have not relied on any oral representations, statements, or inducements apart from the terms contained in this agreement. I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future. I understand I can choose not to sign this document and free myself from its terms and the associated risks of the activity by simply not participating in the activity and choosing some other activity available to me that has a lower level of risk to me. I further understand this is a voluntary, extracurricular activity; therefore it is not required for me to obtain college credits and not participating in this activity will in no way hinder my ability to obtain a degree from the university. While I understand alternative activities are available to me that do not have the risks associated with this activity I still desire to voluntarily engage in this activity.
SIGNING THIS DOCUMENT INVOLVES THE WAIVER OF VALUABLE LEGAL RIGHTS.
CONSULT YOUR ATTORNEY BEFORE SIGNING THIS DOCUMENT.
SIGNED this _______ day of ____________________________, 20________.
Participant Signature: ________________________________________________
Printed Name: _______________________________________________________
Participantâ€™s Date of Birth: ____________________________________________
Parent or Legal Guardian Signature: ____________________________________
(If Participant is under 18 years old)
Parent or Legal Guardian Printed Name: _________________________________
(If Participant is under 18 years old)
This document should remain on file for two years after the date of event.
In case of emergency, contact _________________________
at the following number _________________________
Health Insurance Company Name _________________________
Policy Number _________________________
Automobile Insurance Company Name _________________________
Policy Number _________________________
Please list any special services you may require due to an existing medical condition or
physical disability: _________________________
TALENT RELEASE WAIVER
1. I authorize Texas A&M University and its agents to photograph, videotape, audio record, televise, duplicate, and/or otherwise record my image, voice, and likeness. I understand that Texas A&M will own these recordings.
2. I irrevocably authorize Texas A&M and its agents to use, display, publish, and distribute these recordings for any purpose on websites, publications, broadcasts, displays, and any other medium, and to offer these recordings to others for use in non-university mediums.
3. I waive any right to inspect or approve these recordings or material that may be used with them now or in the future, whether that use is known to me or not.
4. I release Texas A&M, its regents, employees, and agents from all liability arising out of the use of these recordings, including but not limited to any claims arising out of my right of privacy or right of publicity and any claims based on any distortions, optical illusions, or faculty mechanical reproductions.
5. I understand that I will not be compensated for any use of these recordings.
6. I understand that this is a legal document and represent that I have read it and understand it and am signing it voluntarily.
______________________________________________ ________________________ Signature Date
______________________________________________ ________________________ Printed Name Cell Phone
______________________________________________ ________________________ Email Address Expected Graduation (If Applicable)
________________________________________________________________________ Permanent Address
If under age 18, a parent or guardian must complete the following:
______________________________________________ ________________________ Parent/Guardian Signature Date
______________________________________________ ________________________ Parent/Guardian Printed Name Relationship
________________________________________________________________________ Parent/Guardian Address
WAIVER: I, the undersigned participant (and my parent or guardian if I am younger than 18 years of age), intending to be legally bound, do hereby forever release and waive any and all rights, claims, and actions for damages that we, our heirs, executors, administrators, and assigns may have, or that may hereafter accrue against any and all persons, organizations, and other entities associated with the event, including, but not limited to Race Entry, USA Track and Field, sponsors, affiliates, volunteers, Gladiator Dash, and individual Gladiator Dash organizers, arising out of or in connection with my involvement before, during, or after the event.
I verify that I am physically fit and sufficiently trained to participate in this event and I assume the risks involved in this activity. I further attest that I will be mindful of traffic along the race course, and hold said sponsors and organizers blameless in any harm that may happen.
I also acknowledge understanding that the charge to my card will show up as Race Entry. I acknowledge that the online processing fees and charitable donations are non-refundable. I also acknowledge that any charitable donations will have 4.97% withheld from the donation to pay credit card and administrative costs.
Race Entry shall not be liable to you for any direct, indirect, special, incidental, consequential or exemplary damages including, but not limited to, loss of profits, goodwill, use, data or other intangible loses. Race Entry does not guarantee the completeness or accuracy of any information contained in, or provided in conjunction with the http://www.raceentry.com website. Race Entry is not responsible for any omissions or inaccuracies, or for the results obtained from this information.
Race Entry facilitates registration for various events, some of which allow participants under the age of thirteen (13). We require a submission of birth date for all registration entries. For children under the age of thirteen (13), parental or guardian consent is required.
You agree that the statutes and laws of the State of Utah, USA, will apply to all matters relating to this Agreement and Waiver. You irrevocably consent that exclusive jurisdiction for any dispute with Race Entry relating to this Agreement and Waiver resides in the courts of Utah, and you further agree and expressly consent to the exercise of personal jurisdiction in the courts of Utah in conjunction with any such dispute including any claim involving Race Entry .