RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY
AGREEMENT
I, hereby acknowledge that Participant has voluntarily elected to enroll in a summer
camp (“Program”), to be held in and around Otterbein University’s Campus, on [insert
date]. I further understand that if Participant is a minor, then I, as his or her parent or
legal guardian must agree to all of the conditions set forth below on behalf of the minor
even where the language is specifically directed to Participant In consideration for being
permitted by Otterbein University (“Otterbein”) to participate in the Program, I hereby
acknowledge and agree to the following:
PROMOTIONAL RIGHTS: As a condition of my participation, I hereby grant Otterbein, the right to use, for
promotional purposes only, any photographs of me taken by Otterbein, its employees or
agents, during my participation in the Program. I further understand and agree that
Otterbein may use (for marketing purposes) any statements or quotes attributed to me
in my evaluation of the Program.
RULES AND REQUIREMENTS: I agree to conduct myself in accordance with Otterbein’s policies and procedures,
including all policies and protocols in place in an effort to slow down or stop the spread
of communicable disease, including COVID-19. I further agree to abide by all the rules
and requirements of the Program. I acknowledge that Otterbein has the right to
terminate my participation in the Program if it is determined that my conduct is
detrimental to the best interests of the group, my conduct violates any rule of the
Program, or at Otterbein’s discretion.
INFORMED CONSENT: I have been informed of and I understand the various aspects of the Program. I
understand that, as a Participant in the Program, I will engage in physical activities,
which may pose a risk of harm, including the risk of contracting communicable disease.
I understand that these activities include but are not limited to: playing, observing or
participating in Program activities, traveling to and from Program events.
I further understand and agree that the risks involved in this Program may include, but
are not limited to: travel to and from Program site, including via private vehicle, common
carrier, and/or Otterbein owned vehicle; contraction of communicable disease; injury
resulting from falls, athletic, physical or other game-like activities during the Program as
a result of the activity area’s conditions, the acts of third parties or other unknown safety
hazards; injuries due to conditions of equipment, unpredictability of weather, wildlife,
negligent first aid operations, and other risks that may not be known to me or not reasonably foreseeable at this time and during my participation. These serious personal injuries and possible death may not only be a consequence of Releasees’ (as defined
herein) actions, inactions, negligence or fault, but also the actions, inactions, negligence
or fault of others, conditions of equipment used, facility conditions, weather conditions,
negligent first aid operations and procedures, and other risks not known to me or not
reasonably foreseeable at this time. I further understand and agree that any injury,
illness, damage, disability, or death that I may sustain by any means is my sole
responsibility, except as explicitly specified in this Agreement. I further understand that
the Program in which I am participating involves or may involve inherently dangerous
activities in which I could sustain injuries, including but not limited to serious personal
injuries including concussions, cardiac problems, illness, damage, or even death as a
consequence. These injuries may be the result of my own actions or inactions or those
of others, conditions of equipment used, facility conditions, weather conditions,
negligent first aid operations and procedures, and other risks not known to me or not
reasonably foreseeable at this time.
I further acknowledge that I have read and understand the NCAA Concussion Fact
Sheet (attached via email) and am aware of the following information:
1. A concussion is a brain injury for which I am immediately responsible for
reporting to Otterbein’s camp physician, trainer or counselor.
2. A concussion can affect my ability to perform everyday activities, including
reaction time, balance, sleep, concentration, and classroom performance.
3. It is my responsibility to report to the camp counselor if I receive a blow to the
head or body and experience signs or symptoms of a concussion or brain injury,
which may include: headache, blurred vision, weakness in one arm or leg, loss of
consciousness, stumbling, loss of balance, nausea/vomiting, confusion, memory
loss, or change in personality (including irritability and depression). I understand
that I must report this immediately and as soon as I am physically capable of
doing so.
4. I may notice some symptoms of a concussion immediately, but other symptoms
may show up hours or days after the initial injury. It is my responsibility to report
any delayed signs or symptoms to the camp counselor.
5. If I suspect a fellow camper has a concussion, I am responsible for immediately
reporting his or her injury to the camp counselor.
6. I will not return to play in a game or practice if I have received a blow to the head
or body that results in concussion-like symptoms until I am cleared by a member
of Otterbein’s staff.
7. Following a concussion, the brain needs time to heal. I am more likely to have a
repeat concussion if I return to play before my symptoms resolve. In rare cases,
repeat concussions can cause permanent brain injury or death. Because of this, I
understand it is important to accurately report all continuing signs and/or
symptoms if I have been diagnosed with a concussion.
ASSUMPTION OF RISK: I understand and acknowledge that there are
potential dangers incidental to my participation in the Program, including risks of
damage, bodily injury, illness, and possibly death as described throughout this
Agreement. The risks may result from the Program itself, from the acts of others, from
use of the equipment or organization of or unavailability of emergency medical care. I
understand that there are risks attendant to physical activities associated with the
Program and that there are potential dangers which may expose me to the risk of
personal injuries, illness, damage, or even death. In addition, I understand that
participation in the Program involves activities incidental thereto, including, but not
limited to, travel to and from the site of the Program, participation at sites that may be
remote from available medical assistance, and the possible reckless conduct of other
participants. I understand that these potential risks may include, but are not limited to:
travel via private vehicles, common carriers, and/or Otterbein-owned vehicles, local
transportation, communicable disease, weather conditions, facility conditions,
equipment conditions, negligent first aid operations or procedures of Releasees (as
defined herein), and that there may be other risks not known to me or not reasonably
foreseeable at this time.
I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, BOTH KNOWN AND
UNKNOWN, EVEN IF ARISING FROM THE ACTS OF THE RELEASEES, UNLESS
THE RISKS ARISE FROM THE RELEASEES’ NEGLIGENCE, GROSS NEGLIGENCE
OR INTENTIONAL MISCONDUCT and I assume full responsibility for my participation
in the Program.
RELEASE AND WAIVER OF LIABILITY: I, on behalf of myself, my personal
representatives, heirs, executors, administrators, agents, and assigns, HEREBY
RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Otterbein, including
its governing board, trustees, directors, officers, employees, and any students, agents
or volunteers acting at Otterbein’s direction (collectively referred to as “Releasees”), for
any and all liability, including any and all claims, demands, causes of action (known or
unknown), suits, or judgments of any and every kind (including attorneys' fees), arising
from any injury, illness, damage or death that I may suffer as a result of my participation
in the Program, REGARDLESS OF WHETHER THE INJURY, ILLNESS, DAMAGE OR
DEATH IS CAUSED BY THE RELEASEES, UNLESS THE INJURY, ILLNESS,
DAMAGE, OR DEATH IS CAUSED BY THE RELEASEES’ NEGLIGENCE, GROSS
NEGLIGENCE OR INTENTIONAL MISCONDUCT, AND REGARDLESS OF WHETHER
THE INJURY, ILLNESS, DAMAGE OR DEATH OCCURS WHILE IN, ON, UPON, OR IN
TRANSIT, TO OR FROM THE PREMISES WHERE THE PROGRAM, OR ANY
LOCATION ADJUNCT TO THE PROGRAM, OCCURS OR IS BEING CONDUCTED.
I further agree that the Releasees are not in any way responsible for any injury, illness,
or damage that I sustain as a result of my own negligent or grossly negligent acts or my own intentional misconduct and I hereby release Releasees from any liability for the same.
Otterbein expressly disclaims liability for actions of third parties, which includes but is
not limited to students, agents or volunteers who are not acting under the direction and
control of Otterbein. I hereby release Releasees from any and all liability, including any
and all claims, demands, causes of action (known or unknown), suits, or judgments of
any and every kind (including attorneys' fees), arising from any injury, illness, damage or
death that I may suffer as a result of actions of any third parties who are not Releasees.
INDEMNITY: I, on behalf of myself, my personal representatives, heirs, executors,
administrators, agents, and assigns, agree to hold harmless the Releasees from any
and all liability, including any and all claims, demands, causes of action (known or
unknown), suits, or judgments of any and every kind (including attorneys' fees), arising
from any injury, illness, damage or death that I may suffer as a result of my participation
in the Program, REGARDLESS OF WHETHER THE INJURY, ILLNESS,
DAMAGE OR DEATH IS CAUSED BY THE RELEASEES OR OTHERWISE, UNLESS
THE INJURY, ILLNESS, DAMAGE OR DEATH IS CAUSED BY THE RELEASEES’
NEGLIGENCE, GROSS NEGLIGENCE OR INTENTIONAL MISCONDUCT.
I further agree that, in the event that I or any of my family members, personal
representatives, heirs, executors, administrators, agents, assigns or any other third
party attempts to assert any claims, demands, causes of action (known or unknown),
suits, or judgments of any and every kind (including attorneys' fees), arising from any
injury, illness damage or death to me, including but not limited to any injury or illness
resulting from my own negligence, gross negligence or intentional misconduct during or
related to the Program, I AGREE TO DEFEND AND INDEMNIFY RELEASEES
AGAINST SUCH CLAIMS, DEMANDS, CAUSES OF ACTION (KNOWN OR
UNKNOWN), SUITS, AND/OR JUDGMENTS OF ANY AND EVERY KIND (INCLUDING
ATTORNEYS' FEES) TO THE FULLEST EXTENT PERMITTED BY LAW.
PERSONAL MEDICAL INSURANCE: I agree to purchase and maintain during the term
of the Program personal medical insurance. I further acknowledge that I am responsible
for the cost of any and all medical and health services I may require while participating
in the Program, or as a result of participating in the Program, except for medical costs
arising from an injury or illness that I sustain that is the direct result of Releasees’
negligence or gross negligence or intentional misconduct. I understand and agree that
Releasees shall not in any way be responsible for other contingent losses arising from
any injury or illness I sustain that is not the result of Releasees’ negligence, gross
negligence or intentional misconduct.
CERTIFICATION OF FITNESS TO PARTICIPATE: I attest that I am physically and
mentally fit to participate in the Program and that I do not have any medical condition,
including injuries and illnesses, that could be aggravated by my participation in the
Program. I further attest that I am responsible for consulting with my health care
provider towards this end. I also certify that I am free from communicable diseases, including, but not limited to, COVID-19, methicillin-resistant staphylococcus aureus (MRSA), and staphylococcus infection.
RESPONSIBILITY FOR REPORTING INJURIES: I acknowledge that I must
be an active participant in my own healthcare and as such, it is my responsibility to
report all injuries and illnesses, including signs and symptoms of concussions, to
Otterbein’s camp staff. I hereby affirm that I have fully disclosed in writing any prior
medical conditions and will also disclose any future conditions to the camp staff.
MEDICAL CONSENT: I understand and agree that Releasees may not have medical
personnel available at the location of the Program. In the event of any medical
emergency, I do authorize and consent to any x-ray examination, anesthetic, medical,
dental or surgical diagnosis or treatment and hospital care that Otterbein personnel
deem necessary for my safety and protection. I understand and agree that Releasees
assume no responsibility for any injury, illness, or damage which might arise out of or in
connection with such authorized emergency medical treatment. I further understand that
in the event that I experience any condition requiring emergency medical treatment,
Otterbein may direct that I be transported to the hospital for such care.
NON-EMPLOYEE STATUS: I understand and acknowledge that in participating in the
Program, I am doing so independently and that I am not an employee or agent of the
Otterbein. I understand and agree that as a non-employee that I am not entitled to
receive compensation or any other employee benefit from Otterbein for my participation
in the Program.
CHANGE OF VENUE: Otterbein reserves the right to change the venue to a
similar venue and/or to change the dates of the Program if the original venue is not
available on the originally planned date. Such change of venue or schedule shall not
void this Agreement.
CHOICE OF LAW: I hereby agree that this Agreement shall be construed in
accordance with the laws of the State of Ohio.
SEVERABILITY: If any term or provision of this Agreement shall be held illegal,
unenforceable, or in conflict with any law governing this Agreement the validity of the
remaining portions shall not be affected thereby.
I hereby acknowledge that I have read, understand, and will abide by each of the terms
and conditions of this Agreement. I understand that I may seek legal counsel of my own
choosing to fully explain any terms of this Agreement to me before I sign it.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor
(those under 18 years of age) and agree that they and the minor are subject to all the
terms of this document, as set forth above.
By signing below the parent or court-appointed legal guardian agrees that they are also
subject to all the terms of this document, as set forth above.
By checking here, you are consenting to the use of your electronic signature in lieu of
an original signature on paper. You have the right to request that you sign a paper copy
instead. By checking here, you are waiving that right. After consent, you may, upon
written request to us, obtain a paper copy of an electronic record. No fee will be charged
for such copy and no special hardware or software is required to view it. Your
agreement to use an electronic signature with us for any documents will continue until
such time as you notify us in writing that you no longer wish to use an electronic
signature. There is no penalty for withdrawing your consent. You should always make
sure that we have a current email address in order to contact you regarding any
changes, if necessary.
I know that running a road race is a potentially hazardous activity. I should not enter and run unless I am medically able to do so and properly trained. I assume all risks associated with running in this event including, but not limited to: falls, contact with other participants, the effects of weather, traffic, and course conditions, and waive any and all claims which I might have based on any of those and other risks typically found in running a road race. I acknowledge all such risks are known and understood by me. I agree to abide by all decisions of any race official relative to my ability to safely complete the run. I certify as a material condition to my being permitted to enter this race that I am physically fit and sufficiently trained for the completion of this event and that a licensed Medical Doctor has verified my physical condition.
In the event of an illness, injury or medical emergency arising during the event I hereby authorize and give my consent to the Event Director to secure from any accredited hospital, clinic and/ or physician any treatment deemed necessary for my immediate care. I agree that I will be fully responsible for payment of any and all medical services and treatment rendered to me including but not limited to medical transport, medications, treatment and hospitalization.
As it applies to my participation in this race, I agree to abide by the Center for Disease Control (CDC)’s recommendations for the prevention of the spread of COVID-19 and attest to having read the CDC’s guidance at: https://www.cdc.gov. I also agree to abide by any COVID-19 distancing and other safety guidelines issued by the state, the community or by this race for my participation in this race.
Further, I grant permission to all the foregoing to use my name, voice and images of myself in any photographs, motion pictures, results, publications or any other print, videographic or electronic recording of this event for legitimate purposes.
This event follows the standard running industry policy: All entry fees are non-refundable. We reserve the right to postpone or cancel the event due to circumstances beyond our control such as a natural disaster or emergency or as required to protect the safety of participants and staff. No refunds will be issued under these circumstances. We reserve the right to change the details of the event without prior notice. I understand that my entry fee is nonrefundable and bib numbers are non transferable.
By submitting this entry, I acknowledge (or a parent or adult guardian for all children under 18 years) having read and agreed to the above release and waiver including the no refund policy.
