Club Sport Passport to Participate

Wheaton College Club Sports

Passport to Participate
Club Sports Medical Information and Release Form
Club Name*
Participant's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Student ID #*
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information
Contact Name*

First NameLast Name
Relationship to Participant
Contact Phone Number*
Please enter a valid phone number.
Medical/Hospitalization Insurance Coverage Information
List relevant emergency medical information (asthma, allergies to medication, previous history of seizures, heart or kidney disease, etc.)
Please check all that apply:*

I am subscribed to the Wheaton College Student Health Insurance Policy.I have coverage through my parents' health insurance or a personal health insurance policy.
If you're covered through your parents or personal health insurance policy, please answer the following:
Name of Agency providing coverage*
Policy Number*
Dates for which coverage is provided from*

MonthDayYear
Date
and to*

MonthDayYear
Date
Are you sure it covers you out of your home state and/or out of Illinois?*

YesNo
By signing below, I verify that: a) I have no physical impairments that might put myself or others in danger by my participation in club sports activities; b) I will abide by all College and applicable club sports regulations regarding my participation; and c) if I become injured in the course of my participation, and am unable to seek treatment for myself, I hereby give permission for emergency medical treatment to be sought for me by representatives of Wheaton College.
Signature of Participant*

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Date Signed*

MonthDayYear
Date
Signature of Parent/Guardian if Participant is a minor

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Date Signed

MonthDayYear
Date

Club Sports Waiver and Release of Liability
Club Name*
Participant's Name*

First NameLast Name
In consideration of my participation in Wheaton College Club Sports, I hereby forever release and covenant not-to-sue Wheaton College, the Wheaton College Board of Trustees, and any of their employees, instructors, volunteers, agents, coaches, athletic trainers, and all others involved, from any and all present and future claims demands, losses, liabilities, obligations, damages, causes of action, and costs (including attorney's fees), resulting from ordinary negligence on the part of Wheaton College or others listed for property damage, personal injury, or wrongful death, arising as a result of my engagingin,or receiving instruction in, club sports or any activities incidental thereto, including travel, wherever, whenever, or however the same may occur. I hereby voluntarily waive any and all claims both present and future, resulting from ordinary negligence, that may be made by me, my family, estate, heirs, or assigns, and I relinquish on behalf of myself, spouse, heirs, estate and assigns the right to recover for injury or death.

I represent and warrant that I am in good health and in good physical condition, and able to participate in the club sport that I have chosen. I agree that I will not undertake any activity that is not within my physical capabilities.

I am aware that club sports at Wheaton College are vigorous team activities that can involve severe cardiovascular stress and violent physical contact. I understand that participation in this activity may involve certain risks. Full disclosure has been made to me of the risks and dangers connected with this activity. I understand that participation in club sports can result in death; coma, paralysis, drowning, stopped breathing, heart attack, stroke, cancer, and infectious disease; head injury, concussion, traumatic brain injury, neck or spinal cord injury, nerve damage, blood clots, complete or partial paralysis, including the loss or impairment of movement, strength, feeling, or use or function of body parts; injury to joints, ligaments, tendons, muscles, internal organs, eyes and skin, including but not limited to cuts, puncture wounds, burns, bruises, sprains, and broken bones; injury that may result in trauma, illness, disease, disfigurement, loss of mobility, speech impairment, vision impairment, blindness, and hearing loss; injury related to falls or collisions with persons or objects; injury that may cause choking, difficulty breathing, hyperventilation, seizure and unconsciousness; injury related to temperature or weather conditions, including dehydration, heat exhaustion, sunburn, heat stroke, frostbite, hypothermia, lightning strike, hail, and strong winds; injury from the use or non-use of sports equipment; injury related to travel; injury due to the inaccessibility of emergency medical care or negligent medical care in the treatment of an injury; injury due to the negligent acts or omissions of College personnel; injury due to the negligent or intentional acts or omissions of teammates, participants, officials, spectators, or others; property loss caused by theft, vandalism, or damage, including property owned by me or property owned by others for whichI am responsible, and other injury or loss not listed regardless of cause.

I understand that such injuries may result in a significant impairment of my future abilities to earn a living, to engage in social and recreational activities, to produce a family, and to enjoy life. I further acknowledge that such injuries can be serious or severe and could last my entire life. I am aware of the risks, dangers, and hazards associated with club sports and the activities incidental thereto, including those listed above as well as those not specified or anticipated. I personally and completely accept these risks including those which may result in my death, injury, illness, and damage to my property, or the property for which I am responsible. I will not hold Wheaton College or those listed liable for any injury or damage associated with my participation in these activities.

I understand and agree that it is my responsibility to provide and use clothing and equipment necessary or required to provide for my own protection and that if equipment is provided to me I am responsible for the safety and good operating condition of this equipment. Regardless of its source, I understand and agree that I will not alter or modify any protective equipment, and that I will read and comply with all warnings provided with any protective equipment. I understand and agree that I am responsible for my personal safety, and the safety of others, to the extent that my actions or inactions may contribute toan injury or loss. I acknowledge that safety overrides all other concerns. Should I become aware of a danger or risk I agree to take appropriate actions, and to communicate these actions to my team captain and to the Director of Club Sports at Wheaton College.

I further agree to indemnify and hold harmless Wheaton College and others listed above for any and all claims arising as a result of my participation in club sports or any activities incidental thereto, wherever, whenever, or however the same may occur. I understand and agree that this agreement, entered into in the State of Illinois, is intended to be as broad and inclusive as permitted by Illinois law, and shall be interpreted, enforced under, and governed by the laws of Illinois. Should any provision of this agreement be held to be illegal, void, or unenforceable, or otherwise held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceedings shall be in the state of Illinois.

I represent and warrant that I have carefully read and understand the terms of this agreement, have been given the opportunity to discuss with a Wheaton College representative of my choosing, the risks and dangers connected with this activity, and have entered into this agreement knowingly, voluntarily, and of my own free will; and intend to abide by its provisions without exception. I affirm that I am of legal age and am freely signing this agreement. I have read this form and fully understand that, by signing this form, I am giving up legal rights and/or remedies which may be available to me for the ordinary negligence of Wheaton College or any of the parties listed above.

CAUTION: READ THIS DOCUMENT CAREFULLY BEFORE SIGNING!
Signature of Participant*

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Date Signed

MonthDayYear
Date
Signature of Parent/Guardian if Participant is a minor

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Date Signed

MonthDayYear
Date

Wheaton College's Athletic Hazing Policy
Wheaton College's Athletic Hazing Policy Wheaton College Athletics exists to develop Christian faith, character and leadership through competitive sports programs by "running the race to win."

As a Christian community, we want to honor Jesus Christ in our relationships with one another and on our teams. Each member of the College community, who acts in a covenant bond with others, should consciously strive to maintain relationships which support, encourage and help others. Wheaton College has a zero tolerance policy on hazing, and the consequences can be severe. Participation in hazing activities may lead to individual disciplinary action, team disciplinary action and/or termination of the team or student organization.

Hazing is defined as any act on or off Wheaton College property by one student acting alone or with others, directed against any other student(s), whether voluntary or involuntary, to subject that student or students to abusive or humiliating pranks or other activities (e.g., initiations, responses to engagements, "kidnappings", etc The following may be some (but certainly not all) forms of hazing:
- All forms of physical activity deemed dangerous or harmful.
- The application of foreign substances to the body.
- Forcing, coercing, or requiring students to drink alcohol or imbibe any illegal or controlled substance, or to eat or drink any foreign or unusual substances.
- Forcing or coercing students to dress in embarrassing attire.
- Nudity or forcing students to dress in a degrading or inappropriate manner.
- Any act which is likely to compromise the dignity of a student; cause embarrassment or shame to a student; cause a student to be the object of ridicule or malicious amusement; or inflict psychological or emotional harm.
- Any mischievous activity that threatens and intimidates or endangers the health, physical, or emotional well-being of a student or that results in damage, malicious vandalism, or general disregard for College or private property.
- Any act undertaken in connection with an initiation to membership for any athletic team, club sport, living unit, or student organization.
The College defines hazing as any action or activity that recklessly endangers the physical or mental health of a person, or that violates the dignity of another person. Hazing is further defined as any activity that is expected of someone to join a group or team that humiliates, degrades, abuses or endangers them, regardless of intention or willingness to participate. Initiation activities and initiation parties fall into this category.

Hazing and Initiations

I have read Wheaton's hazing policy and understand that Wheaton College has a zero tolerance policy regarding hazing.I understand that there are severe penalties for all parties involved in hazing (including suspension/expulsion from the team or school and cancellation of the season I certify I will not engage in hazing or initiation activities. I further agree to provide an environment that is free from harassment of any kind.
Signature of Participant*

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Date Signed

MonthDayYear
Date
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Wheaton College Club Sports