Hiram College
Assumption of Risk Release and Liability Waiver
This is the Assumption of Risk , Release, and Waiver of Liability of Hiram College for all indoor and outdoor activities taking place during the Academic Year. This form
needs to be submitted on an annual basis.
All students must have this form on file to attend events and excursions sponsored by Hiram College, such as by the Office of Campus Involvement. If you do not have this form on file you will not be permitted to attend and/or participate in certain events.
Today's Date:
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Name:
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First
Last
Email:
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Banner ID Number:
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Intended Graduation Year:
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Please fill out and agree to the following:
I,
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am participating in indoor and outdoor social and/or extra-curricular activities sponsored or facilitated by Hiram College or sponsored by a student organization within the College (herein after collectively referred to as "Activities", and individually as an "Activity"). I hereby assume the risk of participation in these activities, where occurrences may create hazards that could place me in perilous situations. The specific risks vary from one Activity to another, and the risks can range from (i) minor injuries such as bruises and strains, to (ii) major injuries such as loss of sight, neck, or back injuries, heart attacks and concussions, to (iii) catastrophic injuries including paralysis and death. I am physically able to participate in the Activities, and know of no disability or prior injury which would prevent my participation in the Activities or potentially lead to my injury or the injury of another person. Upon agreeing to and signing this Assumption of Risk, Release and waiver of Liability of Hiram College, I agree to hold harmless Hiram College, its affiliates, professors, students, independent, contractors,offices, trustees, employees, insurers and agents and others acting on its behalf (the "Released Parties") from and against all claims, actions,suits, procedures, costs, expenses, damages, losses, liabilities (whether known or unknown), demands and responsibility. These include, but are not limited to, medical expenses, attorney fees, and court award arising out of or resulting in bodily injury, sickness, disease, death or injury as a result of the Activities.
I agree to abide by local, state, and federal law while participating in Activities. I further understand that I am not to use illegal substances and not to drink alcohol while participating in these activities (unless of legal drinking age and activity is sponsored by the College). I am to exercise reasonable care and diligence during each Activity. I have read the previous paragraphs and I fully understand that I am releasing the Released Parties.
I fully understand the risk and scope of the activities and hereby assume all risks,known or unknown, for participation in the Activities.
ACKNOWLEDGEMENT:
1. That I am an adult of at least eighteen (18) years of age: or if I am under the age of 18 my parent or legal guardian has read this document, understands it and agrees to be bound by its terms as evidenced by my parent or legal guardian's signature.
2. That I have read this document, understand, and agree to be bound by its terms as witness by my signature below.
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Select a choice
Agree
Disagree
Student Electronic Signature:
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Parent or Legal Guardian Electronic Signature (if under 18):
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Birthdate
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Emergency Contact Information:
Name of Contact Person 1:
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First
Last
Relationship of Contact Person 1:
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Phone Number of Contact Person 1:
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Name of Contact Person 2:
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First
Last
Relationship of Contact Person 2:
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Phone Number of Contact Person 2:
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Known medications:
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Known allergies:
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Copies of this form will be kept on file with the Office of Campus Involvement for the duration of the year and will cover the activities you participate in that are associated with Hiram College ONLY.
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