In consideration of the Governors of The King's University Students’ Association (“TKUSA”) allowing my participation in the above-noted club, I represent and agree as follows:
I am aware that participating in the above-noted event has many inherent dangers, hazards and risks, including but not limited to the following:
GENERAL:
• Theft, loss or damage to personal property;
• Any manner of injury, disability or death arising from travel by car, bus or any other means to and from the above-noted event;
• Any manner of injury, disability or death resulting from use, misuse, non-use and failure of any equipment;
• Illness including food poisoning arising from the provision of food or beverage by restaurants or other service providers;
• Acts by third parties unrelated to the above-noted event.
SPECIFIC:
(specific risks related to this club must be listed by the event leader before the form is submitted to the club member).
1. I am aware that The King's University Students’ Association does not insure students against injury, accident, hospitalization, disability, or death. I acknowledge that it is my responsibility to obtain supplemental medical, hospitalization and disability insurance coverage while participating in events on or off campus. If international travel is involved, I agree to provide evidence of such insurance coverage.
2. To the best of my knowledge, there are no health-related reasons or problems that preclude or restrict my participation in the above-noted club. If this club involves international travel, I agree to obtain and provide evidence of the appropriate medical clearances, such as immunizations, medical advice, and the required level of physical fitness.
3. In the event of an accident or serious illness, I authorize The King's University Students’ Association to obtain medical treatment for me and on my behalf. I agree to hold harmless and indemnify The King's University Students’ Association from any liability, claims, causes of action and/or damages, arising out of or resulting from medical treatment obtained.
4. I give permission to release information provided on this form to TKUSA employees and others including insurance agents and/or emergency medical personnel as required.
5. I agree to make sure that I know how to safely participate in the above-noted club, and I agree to observe any rules and practices, which may be employed to minimize the risk of injury. I agree to stop and seek assistance if I do not believe I can safely continue any activity.
6. I further agree to become familiar with the policies of TKUSA and/or its partners, if applicable, concerning student conduct during on and off-campus events and agree not to violate any directives or instruction made by the persons in charge of the above-noted event. I understand that failure to obey directives may result in my expulsion from any remaining portion of the above-noted event.
7. I knowingly and freely accept and fully assume any risks, dangers and hazards, whether known or unknown, and the possibility of personal injury, illness, death, property damage or loss, resulting from my participation in the above-noted event. I release, waive and hold harmless TKUSA, its Executive Board, officers, employees and agents from any liability, claims, causes of action and/or damages of any kind relating to or arising out of the above-noted event.
8. This agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives in the event of my death or incapacity.
I have read this Informed Consent and Waiver of Liability, fully understand its terms, and sign it freely and voluntarily without any inducement. I am at least eighteen (18) years of age and fully competent to sign this Informed Consent and Waiver of Liability. If I am not eighteen (18) years of age, my parent or legal guardian has signed on my behalf.