CERTIFICATION OF FITNESS TO PARTICIPATE. I attest that I am physically and mentally fit to participate in the Activity and that I do not have any medical record of history that could be aggravated by my participation in this particular Activity. If I require any reasonable accommodation(s) in order to participate in the Activity, I have notified the sponsor in writing of the nature of the accommodation(s) needed prior to the Activity. MEDICAL CONSENT: I understand and agree DISTRICT is not responsible for my health and safety. Recognizing this, however, I wish to, and hereby do, grant DISTRICT full authority to take, or not to take, in its sole discretion, whatever actions it may consider warranted under the circumstances for my health and safety during my participation in the foregoing event, and I hereby release it from any liability for any such decisions or actions as may be taken in connection therewith. The authority granted in the preceding sentence shall include the right (in the sole discretion of DISTRICT) to place me, at my own expense, and without any further consent, in a hospital, for medical services and treatment, or if no hospital is readily accessible, to place me in the hands of a local medical doctor for treatment. I understand and agree that Releasees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment. CHOICE OF LAW: I hereby agree that this Agreement shall be construed in accordance with the laws of the State of Texas.
CERTIFICATION OF FITNESS TO PARTICIPATE. I attest that I am physically and mentally fit to participate in the Activity and that I do not have any medical record of history that could be aggravated by my participation in this particular Activity. Initial ____________ MEDICAL CONSENT: I understand and agree that Releasees may not have medical personnel available at the location of the Activity. In the event of any medical emergency, I (initial one) do __ do not __ authorize and consent to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care that the UNIVERSITY personnel deem necessary for my safety and protection. I understand and agree that Releasees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment. Initial ____________ I hereby agree that this Agreement shall be construed in accordance with the laws of the State of Washington. I understand that I may seek legal counsel of my own choosing to fully explain any terms of the Agreement to me before I sign it. SEVERABILITY: If any term or provision of this Agreement shall be held illegal, unenforceable, or in conflict with any law governing this Agreement the validity of the remaining portions shall not be affected thereby. I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS. I AM AWARE THAT THIS AGREEMENT INCLUDES A RELEASE AND WAIVER OF LIABILITY, AN ASSUMPTION OF RISK, AND AN AGREEMENT TO INDEMNIFY THE RELEASEES. I UNDERSTAND I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING THIS AGREEMENT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. BY MY SIGNATURE I REPRESENT THAT I AM AT LEAST EIGHTEEN YEARS OF AGE, OR, IF NOT, THAT I HAVE SECURED BELOW THE SIGNATURE OF MY PARENT OR GUARDIAN AS WILL AS MY OWN. _____________________________Signature of Participant ___________________Date Signature of parent/Guardian for Participants under eighteen (18) years of age: I certify that I have custody of Participant or am the legal guardian of Participant by court order. I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS. I AM AWARE THAT THIS AGREEMENT INCLUDES A RELEASE AND WAIVER OF LIABILITY, AN ASSUMPTION OF RISK, AND AN AGREEMENT TO INDEMNIFY THE RELEASEES. I join with Participant in granting a release to releasees as set forth in detail above. _____________________________Signature of Parent/Guardian _________________Date
CERTIFICATION OF FITNESS TO PARTICIPATE. I attest that I (or my minor child) am physically and mentally fit to participate in the Activity and that I (or my minor child) do not have any medical record of history that could be aggravated by my (or my minor child's) participation in this particular Activity.
CERTIFICATION OF FITNESS TO PARTICIPATE. I attest that I/my minor child am physically and mentally fit to participate in the internship and that I/my minor child do not have any medical record of history that could be aggravated by my/my minor child’s participation in the internship. MEDICAL CONSENT: I understand and agree that Releasees may not have medical personnel available at the location of the internship or off-site internship event. In the event of any medical emergency, I (initial one) do____do not____ authorize and consent to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care that LAKE FOREST COLLEGE personnel deem necessary for my/my minor child’s safety and protection. I understand and agree that Releasees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment.
CERTIFICATION OF FITNESS TO PARTICIPATE. I/we attest that Participant is physically and mentally fit to participate in the Program, that I/we have discussed participation in the Program with Participant’s physician, that his/her physician has confirmed that Participant can safely participate in the Program and that he/she does not have any medical record of history that could be aggravated by participation in the Program. I further attest that Participant is physically and mentally fit to participate in the Program. RESPONSIBILITY FOR REPORTING INJURIES: Participant must report all injuries and illnesses, including signs and symptoms of concussions, to the University’s health care provider. I/we affirm that I/we have fully disclosed in writing any of Participant’s prior medical conditions and will also disclose any future conditions to the University’s health care provider. MEDICAL CONSENT: I/we understand and agree that medical personnel may not be available at the location of the Program. In the event Participant experiences any condition requiring emergency medical treatment, the University may direct that he/she be transported to the hospital for such care. I/we understand the Program will first attempt to personally contact me/us. I/we hereby give my/our consent for medical treatment deemed necessary by physicians designed by University authorities. I/we agree that Releasees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment.
CERTIFICATION OF FITNESS TO PARTICIPATE. I attest that I (or my minor child) am physically and mentally fit to participate in the Kick-start Entrepreneurship Camp and that I (or my minor child) do not have any medical record of history that could be aggravated by my (or my minor child's) participation in this particular Kick-start Entrepreneurship Camp.
CERTIFICATION OF FITNESS TO PARTICIPATE. I attest that I am physically and mentally fit to participate in the Activity and that I do not have any medical record of history that could be aggravated by my participation in this particular Activity. MEDICAL CONSENT: I understand and agree that Releasees may not have medical personnel available at the location of the Activity. In the event of any medical emergency, I (initial one) do do not authorize and consent to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care that the UNIVERSITY personnel deem necessary for my safety and protection. I understand and agree that Releasees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment. CHOICE OF LAW: I hereby agree that this Agreement shall be construed in accordance with the laws of the State of Oklahoma.
CERTIFICATION OF FITNESS TO PARTICIPATE. I will assure I am physically and mentally fit to utilize Facilities and equipment that I choose to use. I agree not to use Facilities or equipment for which I have a medical condition or history that could be aggravated by the facilities or equipment. I also am responsible for consulting with my health care provider towards this end. CHOICE OF LAW: I hereby agree that this Agreement shall be construed in accordance with the laws of the State of Washington.
CERTIFICATION OF FITNESS TO PARTICIPATE. I attest that I am physically and mentally fit to participate in the Activity and that I do not have any medical record of history that could be aggravated by my participation in this particular Activity. MEDICAL CONSENT: I understand and agree that Releasees may not have medical personnel available at the location of the Activity. In the event of any medical emergency, I (initial one) do____do not____ authorize and consent to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care that the UNIVERSITY personnel deem necessary for my safety and protection. I understand and agree that Releasees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment.
CERTIFICATION OF FITNESS TO PARTICIPATE. I attest that I am physically and mentally fit to participate in the Activity and that I do not have any medical record of history that could be aggravated by my participation in the particular Activity. MEDICAL CONSENT*: I understand and agree that Releasees may not have medical personnel available at the location of the Activity. In the event of any medical emergency, I (Initial one) do or do not authorize and consent to any x-ray examination, anesthetic, medical, dental or surgical diagnosis or treatment, and hospital care that Hamline University’s personnel deem necessary for my safety and protection. I understand and agree that Releasees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized emergency medical treatment. CHOICE OF LAW: I hereby agree that this Agreement shall be construed in accordance with the laws of the State of Minnesota. I understand that I may seek legal counsel of my own choosing to fully explain any terms of this Agreement to me before I sign it.
