Medical Release
Western Illinois University is committed to conducting sponsored programs and activities in the safest manner possible and holds the safety of participants in the highest possible regard. As a participant in the program, I recognize and acknowledge that there may be risks of physical injury as a result of my or my minor child’s participation. I agree to assume the full risk of any injuries (including death), damages, or loss which I or my minor child may sustain while participating in any and all activities or the use of any and all facilities or equipment associated with the program. Western Illinois University continually strives to reduce such risks and insists that all participants follow safety rules and instructions which have been designed to protect participants’ safety.
Please recognize that Western Illinois University does not carry medical or accident insurance for injuries sustained in its activities or programs. Each person registering to participate should review their own health insurance policy for coverage. It must be noted that the absence of health insurance coverage does not make Western Illinois University automatically responsible for the payment of medical expenses.
Agents, employees and assigns from any and all claims from injuries (including death), damages, or loss which I or my minor child may have or which may accrue by participating in the program.
I further agree to indemnify, hold harmless and defend Western Illinois University, its Board of Trustees, its officers, agents, employees and assigns from any and all claims resulting from injuries (including death), damages and losses sustained by me arising out of, connected with, or in any way associated with the activities of the program.
I will assume responsibility for any miscellaneous charges associated with my minor child’s loss of University property, such as a room key.
In the event of an emergency, I authorize Western Illinois University officials and its Board of Trustees to secure from any licensed hospital, physician, and/or medical personnel any treatment deemed necessary for my or my minor child’s immediate care and agree that I will be responsible for payment for any and all medical services rendered.
I have read and fully understand the above information. I am authorized to and agree to grant said waiver and release and give permission to secure treatment.