If your family has more than one insurance plan available, please provide the information for the primary insurance carrier, this is the insurance that you would first make any claims to if needed.

Participant Safety
Every effort is made to protect the health and safety of all participants on Mid Michigan College (Mid) recreational, intramural, club sports and NJCAA athletic programs. However, participation in many activities involves some risk which may result in injury, disability or death. To provide the safest environment possible, you must follow all rules and regulations established by the Mid staff and coaches and those of the applicable sports facility.

Mid does not maintain any medical coverage for participants nor is there any benefit fund to cover any injury resulting from participation in any activity.  Mid may not provide trained medical personnel or trainers at all sporting events or practices.

Assumption of Risk, Release, and Indemnification
I hereby acknowledge that Mid has warned me that I, by participating in the recreational sports, intramural, club sports program or NJCAA athletic programs, may be injured. Injuries might include, but are not limited to sprains, fractures, ligament or cartilage damage which could result in partial, complete, temporary or permanent impairment in the use of limbs. These and other injuries could also result in brain damage, paralysis or even death.

Even though these injuries might occur, I wish to participate in one or more of the following programs: recreational sports, intramural programs, club sports and NJCAA athletic programs.  I understand and accept that there is no medical coverage or benefit fund for participants in any of these programs and I agree to assume personal responsibility for any injuries that I may suffer as a participant.  I also realize that there will not always be trained medical personnel on site at any of the sponsored program’s practices and contests.

I further expressly agree to release Mid, its employees and agents and anyone else associated with Mid from any and all claims, demands or damages whatsoever, whether developed or undeveloped, known or unknown, anticipated or unanticipated, which I may have now or in the future, including, but not limited to any and all claims, demands or damages for negligence, personal injury and/or loss, theft or destruction or personal property. It is my intention that this release be as broad as allowed under Michigan law.

I further agree to save, hold harmless, and indemnify Mid, its employees and agents and anyone else associated with Mid from any and all claims, demands or damages, including costs, interest and attorney fees which they may suffer or incur as a result of any claims by me or anyone claiming through me and/or as a result of any claims, demands or lawsuits arising out of my actions or those of anyone who comes with me to the premises.

Health Insurance Requirement
I understand that I am required to be covered by a qualified health insurance program.  Additionally, I have provided Mid with proof of personal insurance coverage.  A copy of which is attached.

I have read the foregoing release, I fully understand it, and I agree to be bound by it.

Significant effort has been made to ensure this content meets accessibility guidelines. If you encounter a barrier you can report the barrier at midmich.edu/reportaccessibilitybarrier or contact Athletics at (989) 773-6622 x548 or athletics@midmich.edu.

In its commitment to providing a safe environment, Mid Michigan College actively endeavors to broaden our diversity, promote equal opportunity, and prohibit any form of discrimination in its programs, activities, and conditions of admission or employment. Learn more about these efforts and policies by visiting midmich.edu/eeo, midmich.edu/titleix, midmich.edu/securityreport.