Sport Club Coach Application

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "2015-2016 Sport Club Coach Application"

Transcription

1 Sport Club Coach Application Coach Eligibility Each Sport Club Coach Application will be reviewed and approved, deferred, or denied, by the Sport Clubs Advisor or representative. An individual is not an official coach until their application has been approved and they have submitted the following forms to Student Organizations & Leadership (University Union - 2nd Floor): HR Volunteer Identification Form Coach Contract & Agreement Form Copy of Driver's License Coach Information Contact Information - must be digits long and may include only numbers, hyphens, and spaces. - First name: Middle initial: Last name: address: Phone number: Address: City: State: ZIP: Date of Birth MM/DD/YYYY Sac State ID# Complete if you are a Sacramento State student. - Numeric - ex: must be between 9 and 9 characters. Years of Participation Please select the total number of years you have coached this club. - must select a value. [ ] New Coach [ ] 1 [ ] 2 [ ] 3 [ ] 4 [ ] 5 [ ] 6 Are you interested in becoming a driver for your sport club? Becoming an approved driver is mandatory in order to drive yourself and/or others to and from competitions/events. [ ] Yes [ ] No Are you CPR and First Aid Certified? If you check yes, please bring copies of your valid CPR and First Aid cards to Student Organizations & Leadership (2nd floor of the University Union). Write your club name on the copy. [ ] Yes [ ] No Club Selection Page 1 of Sport Club Coach Application

2 What sport club(s) are you applying for? [ ] Baseball [ ] Bass Fishing [ ] Cycling [ ] Gymnastics [ ] Men's Rowing [ ] Men's Rugby [ ] Men's Soccer [ ] Men's Volleyball [ ] Racquetball [ ] Rock Climbing [ ] Running [ ] Ski & Snowboard [ ] Tennis [ ] Triathlon [ ] Ultimate [ ] Wakeboard [ ] Women's Rugby [ ] Women's Soccer [ ] Women's Volleyball [ ] Wrestling Emergency Contact Information Emergency Contact Name Emergency Contact Phone Number - must be digits long and may include only numbers, hyphens, and spaces. Emergency Contact Address - Your Relationship to the Emergency Contact Emergency Contact Notification I authorize Sacramento State and/or my club to notify my Emergency Contact in the case of an emergency. Adult vs. Minor Are you 18 years of age or older? If under 18 years of age, your parent/legal guardian must submit a paper copy of the release of liability (located in the files section) to the Student Organizations & Leadership Office. You will not be eligible to participate until this has been done. - must select a value. [ ] Yes, I am 18 years of age or older [ ] No, I am under 18 years of age Minor Information You have indicated that you are under the age of 18. For this reason, your parent/guardian must approve your participation in Sport Clubs. Please visit the below link to access the paper waiver and submit to Josh Mandel-Sonner (Sport Clubs Advisor) at Student Organizations & Leadership (2nd floor of University Union). Page 2 of Sport Club Coach Application

3 YOU ARE NOT ELIGIBLE UNTIL YOUR APPLICATION HAS BEEN APPROVED (including submitting this document) RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activities & Hazards Activity: Participation in California State University, Sacramento's Sport Club program for the academic year. The Sport Club program includes clubs for baseball, bass fishing, cycling, gymnastics, men's rowing, men's rugby, men's soccer, men's volleyball, racquetball, rock climbing, running, ski & snowboard, tennis, triathlon, ultimate, wakeboard, women's rugby, women's soccer, women's volleyball, and wrestling. Participation includes club meetings, practices, competitions, events, travel and fundraisers. Activity Date(s) and Time(s): effective August 31, August 28, 2016 Activity Location/Facility: As dictated by published and announced schedules. Hazards to be aware of: Those associated with travel, practices and games. Hazard Mitigation: Practices and games: conditioning and techniques as directed by coaches and good practice; Travel: preparation and safe driving practices as recommended by University Risk Management. In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue the State of California, the Trustees of the California State University, California State University, Sacramento and their employees, officers, directors, volunteers and agents (collectively University ) from any and all claims, including claims of the University s negligence, resulting in any physical or psychological injury (including paralysis or death), illness, damages, or economic or emotional loss that I may suffer because of my participation in this Activity, including travel to, from and during the Activity. I am voluntarily participating in this Activity. I am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other s actions, inaction, or negligence; conditions related to travel; or the condition of the Activity locations(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to and from the Activity. I agree to hold the University harmless from any and all claims, including attorney s fees or damage to my personal property that may occur as a result of my participation in this Activity, including travel to, from and during the Activity. If the University incurs any of these types of expenses, I agree to reimburse the University. If I need medical treatment, I will be financially responsible for any costs incurred as a result of such treatment. I AM AWARE AND UNDERSTAND THAT I SHOULD CARRY MY OWN HEALTH INSURANCE. I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the University from all liability, (b) promising not to sue the University, and (c) assuming all risks of participating in this Activity, including travel to, from and during the Activity. I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me. [ ] I agree to the terms and conditions of the above waiver By entering my full name below, I am agreeing to the above release of liability, promise not to sue, assumption of risk and agreement to pay claims. August 1, 2015-August 30, RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Page 3 of Sport Club Coach Application

4 RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activities & Hazards Activity: Participation in California State University, Sacramento's Sport Club program for the academic year. The Sport Club program includes clubs for baseball, bass fishing, cycling, gymnastics, men's rowing, men's rugby, men's soccer, men's volleyball, racquetball, rock climbing, running, ski & snowboard, tennis, triathlon, ultimate, wakeboard, women's soccer, women's volleyball, and wrestling. Participation includes club meetings, practices, competitions, events, travel and fundraisers. Activity Date(s) and Time(s): effective August 1, August 30, 2015 Activity Location/Facility: As dictated by published and announced schedules. Hazards to be aware of: Those associated with travel, practices and games. Hazard Mitigation: Practices and games: conditioning and techniques as directed by coaches and good practice; Travel: preparation and safe driving practices as recommended by University Risk Management. In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue the State of California, the Trustees of the California State University, California State University, Sacramento and their employees, officers, directors, volunteers and agents (collectively University ) from any and all claims, including claims of the University s negligence, resulting in any physical or psychological injury (including paralysis or death), illness, damages, or economic or emotional loss that I may suffer because of my participation in this Activity, including travel to, from and during the Activity. I am voluntarily participating in this Activity. I am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other s actions, inaction, or negligence; conditions related to travel; or the condition of the Activity locations(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to and from the Activity. I agree to hold the University harmless from any and all claims, including attorney s fees or damage to my personal property that may occur as a result of my participation in this Activity, including travel to, from and during the Activity. If the University incurs any of these types of expenses, I agree to reimburse the University. If I need medical treatment, I will be financially responsible for any costs incurred as a result of such treatment. I AM AWARE AND UNDERSTAND THAT I SHOULD CARRY MY OWN HEALTH INSURANCE. I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing the University from all liability, (b) promising not to sue the University, and (c) assuming all risks of participating in this Activity, including travel to, from and during the Activity. I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me. to the terms and conditions of the above waiver. By entering my full name below, I am agreeing to the above release of liability, promise not to sue, assumption of risk and agreement to pay claims. Health Insurance Information This section is for emergency contact information in case of personal injury or accident when under the auspices of Sacramento State Sport Clubs. All CLUB MEMBERS and COACHES are encouraged (but not required) to have primary health insurance. All members and coaches of a sport club participating in regularly scheduled practices and games will be covered under the CSU Club Sports Insurance Program. Under the terms of the coverage, Sacramento State's insurance is a SECONDARY CARRIER and its policy is accessed only in the event the student or student's primary insurance does not cover the entire bill. Exclusion or failure to provide accurate insurance information below, will result in the non-payment of medical bills received as a result of sport club participation, and may also result in expulsion from the team. Also, anytime alcohol or drugs are involved the CSU Club Sports Insurance is null and void. By entering my full name below, I acknowledge that I have read the above statement regarding health insurance coverage. - must contain at least 4 characters. Do you have Health Insurance? [ ] Yes [ ] No Primary Health Insurance Health Insurance Company Who is your medical provider (ex. Kaiser, Blue Cross of California, Blue Shield, Medi-Cal, etc.) Page 4 of Sport Club Coach Application

5 Policy # This number typically appears on the front or back of your health insurance card (i.e. Kaiser card, Blue Cross card, Blue Shield card, Medi-Cal card, etc.) Policy Holder Name: Who is the policy holder? Your Relationship to the Insurance Policy Holder What is your relationship to the policy holder? Group # Health Insurance Company Phone Number - must be digits long and may include only numbers, hyphens, and spaces. Health Insurance Information I verify that the health insurance information I provided is accurate, and agree to notify Student Organizations and Leadership if the status of my health insurance coverage changes, Health Insurance Information (cont.) Health Insurance Statement I verify that Sacramento State Sport Clubs has strongly recommended to me the value of having my own health insurance policy. Further, I understand that if I choose to participate in Sport Clubs without my own health insurance policy and am injured, my legal options will be as detailed in the "Release of Liability, Waiver of Right to Sue, Assumption of Risk and Agreement to Pay Claims" document I have signed. By entering my full name below, I acknowledge that I have read the above statement regarding health insurance coverage. - must contain at least 4 characters. Sacramento State Sport Clubs Program - Concussion Statement of Responsibility Personal Responsibility I understand that it is my responsibility to report all injuries to the Sport Clubs Advisor. Concussion Management Policy Please see the link below for the Sacramento State Sport Clubs Concussion Management Policy. This information can also be found in the files section of OrgSync. [ ] I confirm that I have read and been given access to the Sacramento State Sport Clubs Concussion Management Policy. I understand the following information regarding concussions and will abide by the appropriate protocol outlined below: Page 5 of Sport Club Coach Application

6 A concussion is a brain injury, which I am responsible for reporting to the Sport Clubs Advisor, and my club's Safety Officer and President. A concussion can affect an individual's ability to perform everyday activities, and affect reaction time, balance, sleep, and classroom performance. You cannot see a concussion, but you might notice some of the symptoms right away. Other symptoms can show up hours or days after the injury. If I suspect a club member has a concussion, I am responsible for reporting the injury to the Sport Clubs Advisor, and my club's Safety Officer and President. I will not allow a club member to return to play in a game or practice if they have received a blow to the head or body that results in concussion-related symptoms. I will follow the Return to Play protocol set forth by the Sport Clubs Program. Following a concussion, the brain needs time to heal. An individual is much more likely to have a repeat concussion if they return to play before their symptoms resolve. In rare cases, repeat concussions can cause permanent brain damage, and even death. By entering my full name below, I am agreeing to the above Sacramento State Sport Clubs Program Concussion Statement of Responsibility. Driving Page 6 of Sport Club Coach Application

7 You have indicated that you are interested in becoming a driver for your sport club. Sport Club drivers must do the following before they are approved to drive to and from sport club competitions: - Complete the Sac State Sport Clubs Driving Packet - Complete the Defensive Driver Training Course (link can be found on cover page of Driving Packet) - Submit a copy of driver's license - Submit a copy of valid vehicle insurance - Submit signed/dated Defensive Driver Training - Online Self-Certification Acknowledgement *Please visit the link below to access the driving packet and the link for the Defensive Driver Training Online Course. Once you have completed the driving packet and online course, please submit the completed packet, signed/dated Defensive Driver Training certificate, copy of driver's license, and copy of valid vehicle insurance to Josh Mandel-Sonner (Sport Clubs Advisor) at Student Organizations & Leadership (2nd floor of University Union). YOU ARE NOT ELIGIBLE TO DRIVE TO AND FROM SPORT CLUB COMPETITIONS UNTIL BOTH YOUR DRIVING PACKET AND SPORT CLUB COACH APPLICATION HAVE BEEN APPROVED. Student Organizations & Leadership Handbook All sport club members and coaches are responsible for abiding by the policies covered in the Student Organization Handbook and Student Conduct Code. Links to both documents are provided below: Student Organization Handbook: Student Conduct Code: *The Student Organization Handbook includes a Sport Clubs Addendum (pages ). Sport Clubs Transgender Policy Transgender Policy Certain club sports are gender specific based on the league/conference that the club competes under. In order to comply with league/conference rules and National Governing Body rules, club members and coaches need to familiarize themselves with the Sport Clubs Transgender Policy. Please visit the link below. This information can also be found in the files section of OrgSync. that I have read and will follow the Sport Clubs Transgender Policy. Title IX Information The California State University (CSU) is committed to creating and sustaining an educational and working environment free of Sex Discrimination, Sexual Harassment, Sexual Misconduct, Dating and Domestic Violence, and Stalking. California state law mandates that universities provide education on the issues of sexual violence to all students. Title IX prohibits discrimination in educational institutions and requires that all colleges and universities receiving federal funding provide information and education to all incoming students. It also requires that students be made aware of all university policies and procedures regarding discrimination, harassment, and violence as well as the potential outcomes for policy violation. What is "sexual violence"? Sexual Violence is a form of Sexual Harassment and means physical sexual acts, such as unwelcome sexual touching, Sexual Assault, Sexual Battery, Rape, Domestic Violence, Dating Violence, and Stalking (when based on gender or sex) perpetrated against an individual against his or her will and without consent or against an individual who is incapable of giving consent due to that individual's use of drugs or alcohol, status as a minor, or Disability. (CSU Policy Executive Order 1095) Facts About Sexual Assault Sexual assault is an act of violence, sex is the weapon Sexual violence affects everyone. Sexual violence can happen to anyone, anywhere at any time. Most people tell the truth about sexual assault. Only 2-8% are false reports Most (86%) of sexual assaults are perpetrated by a non-stranger. (NISVS 2010) Most men don t rape, but the few that do, commit multiple rapes as well as other assault. Majority of perpetrators remain undetected in our community they are not caught. Page 7 of Sport Club Coach Application

8 FACTS ABOUT RELATIONSHIP VIOLENCE 1 in 4 women will be a victim of relationship abuse. 85% of victims of physical relationship abuse are women. Women ages are at the greatest risk of nonfatal relationship abuse. 20%-30% of college dating couples experience at least one act of physical aggression % of college dating couples experience psychological aggression. Campus Resources for Reporting Sexual Violence Office for Equal Opportunity: Sacramento State Police Department: *For more information about Title IX and sexual violence or harassment, please visit *For more information on bystander intervention education, please contact Sport Clubs Advisor, Josh Mandel-Sonner at or (916) Sexual Violence Oath that I have been given campus resources to aid in the report of sexual violence Mandatory Reporter [ ] I acknowledge that I must report allegations of sexual violence by utilizing the campus resources covered above. Policies Specific to Sport Clubs Regarding Alcohol and Drugs Policies Specific to Sport Clubs Regarding Alcohol and Drugs a. Sport Club members and coaches are required to be drug and alcohol free when involved in Sport Club travel, practice, competition, event, or function. This includes being under the influence of, or in possession of, any intoxicating or illegal drug and/or the misuse of prescription drugs. b. Wearing Sport Club team uniforms, jerseys, or other team paraphernalia while consuming alcohol or at a drinking establishment, regardless of age, is prohibited. c. Promoting or advertising Sport Clubs while consuming alcohol or at a drinking establishment is prohibited. d. Clubs are at all times responsible for guests, spectators, and participants at their events, and will be held accountable for the actions of these persons. e. Sport clubs are responsible for refusing admission to their activities of persons under the influence or in possession of alcoholic beverages. f. If needed, the club must provide gate attendants to assist in preventing alcohol from entering the facility. By checking the box below, I agree to the policies stated above. I understand that failing to abide by these polices can result in the loss of eligibility for Sport Club participation and individual/team sanctions. By entering my full name below, I am agreeing that I have read and understand the policies above and will report violations as soon as they are brought to my attention. Media Release Media Release I release to Sacramento State Sport Clubs, Student Organizations & Leadership, and Sacramento State the use of any picture(s), video(s), or likeness(es) taken or created by an agent of Sacramento State Sport Clubs, Student Organizations & Leadership, or Sacramento State for future use. Additional Paperwork The following two forms and a copy of your driver's license must be on file with Student Organizations & Leadership in order to coach a sport club team. We will send you these forms via once your application has been processed. A parking pass request form will also be ed to you so that you can request a complimentary parking pass. HR Volunteer Identification Form Coach Contract & Agreement Form (must be signed by the club president & treasurer) Page 8 of Sport Club Coach Application

9 Application Signature By entering my full name below, this serves as an electronic signature for this application. Page 9 of Sport Club Coach Application

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition.

California Polytechnic State University, Pomona Vietnamese Student Association. Family. Honor. Tradition. California Polytechnic State University, Pomona Vietnamese Student Association Family. Honor. Tradition. ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM Name of Activity or Event: CAL POLY POMONA VSA WINTER

More information

Date: January 06, 2011 Subject: Technical Letter re: Liability Waivers Handbook Code: RM 2011-01

Date: January 06, 2011 Subject: Technical Letter re: Liability Waivers Handbook Code: RM 2011-01 To: From: Campus Risk Managers Charlene Minnick, Assistant Vice Chancellor, Systemwide Risk Management & Public Safety C: Campus Presidents Gail Brooks, Vice Chancellor, Human Resources Chris Helwick,

More information

MA in Psychology: Behavior Analysis (MABA) Practicum Forms

MA in Psychology: Behavior Analysis (MABA) Practicum Forms MA in Psychology: Behavior Analysis (MABA) Practicum Forms Please note that the MABA program requires two semesters of practicum. Practicum classes are available in the Fall and Spring semesters. You must

More information

2015-16 Insurance Information Insurance coverage

2015-16 Insurance Information Insurance coverage 2015-16 Insurance Information Insurance coverage At USA Wrestling, our top priorities are safety and security. That's why we make sure you're covered by General Liability, Accidental Medical Expense, and

More information

PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT PARTICIPANT AGREEMENT RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I, the undersigned, on behalf of my minor child: ( Participant ), hereby acknowledge that Participant has

More information

ECKERD COLLEGE RELEASE AND WAIVER: CAMP PROGRAMS PARTICIPANTS

ECKERD COLLEGE RELEASE AND WAIVER: CAMP PROGRAMS PARTICIPANTS ECKERD COLLEGE RELEASE AND WAIVER: CAMP PROGRAMS PARTICIPANTS Summer Watersports Camp All-Sports Camp Baseball Camp Basketball Camp Golf Camp Sailing Camp Soccer Camp Softball Camp Tennis Camp Volleyball

More information

Name of Coach: Qualifications: (Attach resume) Please list qualifications and experiences relating to coaching this activity:

Name of Coach: Qualifications: (Attach resume) Please list qualifications and experiences relating to coaching this activity: University of California, Irvine Campus Recreation CLUB SPORTS VOLUNTEER COACH AGREEMENT PLEASE PRINT LEGIBLY Name of Sport Club: Year: Name of Coach: Home Address: Daytime Phone #: Cell Phone #: E-mail

More information

Release of Liability. Printed Name of Participant:

Release of Liability. Printed Name of Participant: Release of Liability IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy

More information

GATEWAY DISCOVERY CAMP

GATEWAY DISCOVERY CAMP GATEWAY DISCOVERY CAMP SUMMER 2 0 1 6 REGISTRATION FORM Gateway Science Museum will host three sessions of the Gateway Discovery Camp. All sessions run 9am to 3pm and include daily snacks and lunches.

More information

ACADEMIC PROGRAM AND CREDIT Participants will register for three (3) units of SDSU resident credit:

ACADEMIC PROGRAM AND CREDIT Participants will register for three (3) units of SDSU resident credit: APPLIED HEALTH & HUMAN SERVICES IN THAILAND: SUMMER MAY 24 JUNE 13, 2012 (ACADEMIC PROGRAM) MAY 31 - JUNE 12, 2012 (FIELD EXPERIENCE) TOTAL PROGRAM FEE: $2,287 PROGRAM HIGHLIGHTS Workshops on Thai culture,

More information

[;)f. California State University Student Travel. Executive Order No. 1041

[;)f. California State University Student Travel. Executive Order No. 1041 THE AL FORNIA STATE UNIVERSITY O FFICE OF THE-C l-!ancellor BAKERSFIELD May 29,2009 CHANNEL ISLAN D S CI-IlCO MEM O RAN DUM DOMINGUEZ I-IILLS EAST BAY TO: CSU Presidents FROM: Charles B. Reed /} Chancellor

More information

SOMN.org SOMN.ORG. Special Olympics Minnesota Unified Sports: Minnesota Schools

SOMN.org SOMN.ORG. Special Olympics Minnesota Unified Sports: Minnesota Schools SOMN.org SOMN.ORG Special Olympics Minnesota Unified Sports: Minnesota Schools 1 TABLE OF CONTENTS Students with Disabilities & Legal Obligations...3 Starting a Special Olympics Club...4 Unified Sports...5

More information

SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS

SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS I, ( ) the undersigned student wish to participate in a study abroad Program offered by Saint Louis

More information

Santa Monica College Administrative Regulation - Students Activities and Student Conduct

Santa Monica College Administrative Regulation - Students Activities and Student Conduct Santa Monica College Administrative Regulation - Students Activities and Student Conduct (AR5319-091481) Extracurricular Trips Arrangements for trips by clubs and other non-athletic extracurricular activity

More information

Thank you again for your interest in volunteering. We look forward to your participation with SPORTS for Exceptional Athletes.

Thank you again for your interest in volunteering. We look forward to your participation with SPORTS for Exceptional Athletes. Welcome Volunteer, SPORTS for Exceptional Athletes would like to thank you for your interest in volunteering for our program. SPORTS for Exceptional Athletes (S4EA) is a community based sports program

More information

Insurance Information INSURANCE COVERAGE

Insurance Information INSURANCE COVERAGE Insurance Information INSURANCE COVERAGE At USA Wrestling, our top priorities are safety and security, that s why we make sure you re protected by insurance coverage considered to be among the most extensive

More information

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING

CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING CHICAGO RUNNING TOURS & MORE, LLC WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT PLEASE REVIEW THOROUGHLY BEFORE SIGNING The undersigned, in consideration of being permitted to participate

More information

Indemnity to ERC, and to Minor Release

Indemnity to ERC, and to Minor Release Universal Release of Liability This is a release of claims, a waiver of liability, an assumption of risk, and an indemnity agreement. By signing this document, you will irrevocably waive and release certain

More information

Midwest Cheer Elite All-star Hip Hop Information 2015-2016

Midwest Cheer Elite All-star Hip Hop Information 2015-2016 Midwest Cheer Elite All-star Hip Hop Information 2015-2016 Welcome to Midwest Cheer Elite, Inc. We are delighted that you have chosen to become a part of one of the top All-Star programs in the Midwest!

More information

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes)

WELCOME TO YMCA Teen Scene Middle School Enrichment Program (This sheet is for parents to keep for informational purposes) Robert D. Fowler Family YMCA Middle School Enrichment Program Student Registration Form 2015-16 Ivy Prep Academy Program Hours: 7am-7:45am & 4pm-7pm Transportation AM: Group leaves at 7:30am Transportation

More information

VOLUNTEER ATHLETIC COACHES RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

VOLUNTEER ATHLETIC COACHES RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT VOLUNTEER ATHLETIC COACHES RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I, ( Volunteer ), desire to participate as a volunteer athletic coach in the ( Program ) on. I acknowledge

More information

Math + Leadership Camp at CSUSM Registration Forms

Math + Leadership Camp at CSUSM Registration Forms Math + Leadership Camp at CSUSM Registration Forms CONTACT INFORMATION Math for America San Diego Email: sandiego@mathforamerica.org Phone: 858-822-6284 Registration Checklist Complete all sections of

More information

MEMBERSHIP/BOAT SUPPORT APPLICATION

MEMBERSHIP/BOAT SUPPORT APPLICATION MEMBERSHIP/BOAT SUPPORT APPLICATION Family memberships include no more than two adults per household and their unmarried rowing children under the age of 21 (or currently enrolled in school up to age 23).

More information

Travel Grant Application Fall 2015 October 23 Deadline

Travel Grant Application Fall 2015 October 23 Deadline Travel Grant Application Fall 2015 October 23 Deadline The USUAA Student Travel Scholarship program was created by USUAA Student Government and is funded entirely by student fees. Scholarships are awarded

More information

RELEASE OF LIABILITY, INDEMNITY, AND BACKGROUND CHECK AUTHORIZATION AGREEMENT

RELEASE OF LIABILITY, INDEMNITY, AND BACKGROUND CHECK AUTHORIZATION AGREEMENT RELEASE OF LIABILITY, INDEMNITY, AND BACKGROUND CHECK AUTHORIZATION AGREEMENT In consideration, the receipt and sufficiency of which is hereby acknowledged, for being allowed entry into and participation

More information

West Virginia University 2015 Forensic Science Summer Camp

West Virginia University 2015 Forensic Science Summer Camp Thank you for registering for the! This packet contains the following forms that must be completed and returned before the student will be allowed to attend camp: Participant Information Form Event Participant

More information

Motorcycle RiderCourse WAIVERS

Motorcycle RiderCourse WAIVERS Motorcycle RiderCourse WAIVERS General Instructions All pages must be completed and signed. If you have any questions, call (231) 591-5819. Mail completed forms to: Motorcycle Rider Courses, Ferris State

More information

SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS

SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS SAINT LOUIS UNIVERSITY STUDY ABROAD PARTICIPATION AGREEMENT AND ASSUMPTION OF RISK AND RELEASE OF CLAIMS I, ( ), the undersigned student, wish to participate in a study abroad Program offered by Saint

More information

LENS Program Checklist LENS Check performed by: (FOR OFFICE USE ONLY) Signature. LENS Check Results: (Please check one) ACCEPTABLE (5 or few points)

LENS Program Checklist LENS Check performed by: (FOR OFFICE USE ONLY) Signature. LENS Check Results: (Please check one) ACCEPTABLE (5 or few points) Off Campus Trip LENS Check Packet The LENS check packet is required when a student is driving their personal car or driving a rental car to a University approved activity. Return the completed packet to

More information

2015 Tournament Entry Form

2015 Tournament Entry Form Mississippi MS HIGH SCHOOL BASS NATION 2015 Tournament Entry Form ONE FORM PER TEAM Angler #1 Name: Event Location: Angler #2 Name: School Club Name: Team Advisor Name: Ph# Address: City: State: Zip Code:

More information

2014/15 STUDENT-ATHLETE SPORTS PHYSICAL PACKET

2014/15 STUDENT-ATHLETE SPORTS PHYSICAL PACKET 2014/15 STUDENT-ATHLETE SPORTS PHYSICAL PACKET Athlete Information Form Please complete entire form Athlete Name: Athlete Cell: Sex: M F Age: Graduation Year: Sport(s): Allergies: Medications: Emergency

More information

Office Use Only Received On: By:

Office Use Only Received On: By: Office Use Only Received On: By: Coach/Instructor Independent Contractor Agreement Each Club Sport team that has a Coach/Instructor must have all individuals employed by your club sign this form. Name:

More information

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION

2015 ADF School Medical/Insurance Information & Liability Waivers INSURANCE INFORMATION These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we

More information

USA Volleyball, United States Volleyball Association, United States Volleyball, Inc. ( USAV ), USA Volleyball Foundation

USA Volleyball, United States Volleyball Association, United States Volleyball, Inc. ( USAV ), USA Volleyball Foundation INSURANCE PROGRAM USA Volleyball administers a medical and liability insurance program customized specifically for the sport of volleyball. It is designed to respond specifically to the inherent hazards

More information

Policy on Sexual Assault, Stalking, Dating Violence, and Domestic Violence

Policy on Sexual Assault, Stalking, Dating Violence, and Domestic Violence Administrative Regulation 6:2 Responsible Office: Title IX Coordinator / VP Student Affairs Date Effective: 12/3/2014 Supersedes Version: 9/30/2014 (Interim) Policy on Sexual Assault, Stalking, Dating

More information

Bartow County C.E.R.T.

Bartow County C.E.R.T. Dear Applicant, I would like to take this opportunity to thank you for your interest in the Community Emergency Response Team. The CERT Program is presented by the Bartow County Emergency Management Agency

More information

IRELAND STUDY ABROAD APPLICATION May 9 to 22, 2016

IRELAND STUDY ABROAD APPLICATION May 9 to 22, 2016 Page 1 of 7 Please retain this page for your records do NOT submit with the application IRELAND STUDY ABROAD APPLICATION May 9 to 22, 2016 GENERAL INSTRUCTIONS All students who have registered for the

More information

TEXAS A&M UNIVERSITY-COMMERCE WAIVER PACKET

TEXAS A&M UNIVERSITY-COMMERCE WAIVER PACKET TEXAS A&M UNIVERSITY-COMMERCE WAIVER PACKET 1. TAMU-COMMERCE GENERAL WAIVER All camp participants must complete the TAMU-C General Waiver. 2. CAMPUS RECREATION (MRC & ABE) WAIVER If your camp is utilizing

More information

Date: July 10, 2015. CSU Presidents. Vice Chancellor Human Resources. Colleagues:

Date: July 10, 2015. CSU Presidents. Vice Chancellor Human Resources. Colleagues: Office of the Chancellor 401 Golden Shore, 4 th Floor Long Beach, CA 90802-4210 562-951-4411 Email: hradmin@calstate.edu Date: July 10, 2015 To: From: Subject: CSU Presidents Lori Lamb Vice Chancellor

More information

2016/17 USA CYCLING COACHING LICENSE APPLICATION 210 USA CYCLING POINT, COLORADO SPRINGS, CO 80919-2215 PHONE 719-434-4224

2016/17 USA CYCLING COACHING LICENSE APPLICATION 210 USA CYCLING POINT, COLORADO SPRINGS, CO 80919-2215 PHONE 719-434-4224 2016/17 USA CYCLING COACHING LICENSE APPLICATION 210 USA CYCLING POINT, COLORADO SPRINGS, CO 80919-2215 PHONE 719-434-4224 Please review the policies and procedures at the USA Cycling website regarding

More information

WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015

WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015 WESTERN NEW YORK OFFSHORE POWERBOAT ASSOC., INC. 2015 BUFFALO POKER RUN - AUGUST 7-8, 2015 ASSUMPTION AND ACKNOWLEDGMENT OF RISK AND RELEASE OF LIABILITY WAIVER 1. ALL OF THE UNDERSIGNED, DO HEREBY AFFIRMATIVELY

More information

Greenwich Insurance Company (American Specialty) - General Liability National Union Fire Insurance Company Sport Accident

Greenwich Insurance Company (American Specialty) - General Liability National Union Fire Insurance Company Sport Accident II. INSURANCE RECAP Entertainment & Sports Insurance Experts, Inc. 2727 Paces Ferry Road Building Two, Suite 1500 Atlanta, GA 30339 Phone: 678-324-3300 Fax: 678-324-3303 # # # #!$%&'(&)&*&)+,+-& (.&/0*0/01(2)'1/&/,1+)'/+(*,)3&+'0%(,1/,4&)'5&6/,130+0,1('13&7/%2(0,1(8!

More information

Tech Judo Open II Invitational Judo Tournament

Tech Judo Open II Invitational Judo Tournament Tech Judo Open II Invitational Judo Tournament USA Judo Sanction # 2015-12-02 Date: Sunday, February 15, 2015 Tournament Director: Clyde Worthen Tournament Coordinator: Leonardo Victoria Head Referee:

More information

ALCOHOL POLICY FOR GRADUATE AND PROFESSIONAL SCHOOL STUDENT EVENTS

ALCOHOL POLICY FOR GRADUATE AND PROFESSIONAL SCHOOL STUDENT EVENTS ALCOHOL POLICY FOR GRADUATE AND PROFESSIONAL SCHOOL STUDENT EVENTS POLICY STATEMENT Yeshiva University is committed to creating and maintaining an environment that is free of alcohol abuse. The University

More information

Southern California Men's Collegiate Gymnastics Association

Southern California Men's Collegiate Gymnastics Association SC United Application 2016 Packet www.facebook.com/socalcollegegymnast @SCUgymnastics southerncaliforniaunited scugymnastics SC United Team Application Instructions Thank you for your interest in the SC

More information

GENERAL RECOMMENDATION

GENERAL RECOMMENDATION GENERAL RECOMMENDATION Release Authorization Your application will be held until we receive this form. RELEASE AUTHORIZATION To Be Completed by Student Student Signature Student Name Address t/ y/ e/zip)

More information

King s Derby Registration Form

King s Derby Registration Form Thank you for choosing to enter OBIC s where over $4000 in Cash and prizes will be given away!! It is our heart to be able to offer our services to children and special needs individuals at no cost. Currently

More information

MEDICAL BENEFITS CLASS ACTION SETTLEMENT NOTICE OF INTENT TO SUE

MEDICAL BENEFITS CLASS ACTION SETTLEMENT NOTICE OF INTENT TO SUE MEDICAL BENEFITS CLASS ACTION SETTLEMENT NOTICE OF INTENT TO SUE Complete this form if you are a MEDICAL BENEFITS SETTLEMENT CLASS MEMBER seeking to exercise a BACK END LITIGATION OPTION. In addition to

More information

Culinary Arts Academy Admission Application

Culinary Arts Academy Admission Application Culinary Arts Academy Admission Application Institute for Hospitality & Tourism Education and Research 3000 N.E. 151st Street, KCC 3RD FL North Miami, FL 33181-3000 Please download, complete and save the

More information

Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms

Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms Aquaculture, Biology, and Conservation Summer Camp 2015 Registration Forms All forms and payment are due no later than June 15, 2015 Note: There is a $25 non-refundable registration fee, and no refunds

More information

Cornerstone Christian School Athletic Packet 2014-2015

Cornerstone Christian School Athletic Packet 2014-2015 Cornerstone Christian School Athletic Packet 2014-2015 TWELVE VIRTUES FOR THE STUDENT-ATHLETE Athletics serve as an integral piece to the total educational program found at Cornerstone Christian School.

More information

CLUB SPORTS INDIVIDUAL PARTICIPANT REGISTRATION- DEPARTMENT RISK STATEMENT

CLUB SPORTS INDIVIDUAL PARTICIPANT REGISTRATION- DEPARTMENT RISK STATEMENT CLUB SPORTS INDIVIDUAL PARTICIPANT REGISTRATION- DEPARTMENT RISK STATEMENT The following statement is to be read carefully by individuals who are enrolled in and/or participating in activities supervised

More information

UCI SUMMER SESSION 2012 TRAVEL-STUDY PROGRAMS ENROLLMENT PACKET CHECKLIST

UCI SUMMER SESSION 2012 TRAVEL-STUDY PROGRAMS ENROLLMENT PACKET CHECKLIST ENROLLMENT PACKET CHECKLIST Thank you for your interest in UCI Summer Session Travel-Study Programs! Enrollment packets that are not 100% complete will not be processed. You must sign and date all portions

More information

INSTRUCTIONS FOR COMPLETING REGISTRATION. 2. Fill out the forms completely with necessary information and signatures:

INSTRUCTIONS FOR COMPLETING REGISTRATION. 2. Fill out the forms completely with necessary information and signatures: INSTRUCTIONS FOR COMPLETING REGISTRATION 1. Print out the Waiver of Liability, Medical Release Form and Participant Information Sheet attached to this document 2. Fill out the forms completely with necessary

More information

Intersection of Title IX and the Clery Act. What types of incidents must be reported to school officials under Title IX and the Clery Act?

Intersection of Title IX and the Clery Act. What types of incidents must be reported to school officials under Title IX and the Clery Act? Intersection of Title IX and the Clery Act The purpose of this chart is to clarify the reporting requirements of Title IX and the Clery Act in cases of sexual violence and to resolve any concerns about

More information

BON AIR BASKETBALL POLICIES & PROCEDURE MANUAL

BON AIR BASKETBALL POLICIES & PROCEDURE MANUAL BON AIR BASKETBALL POLICIES & PROCEDURE MANUAL October 15, 2014 10/15/2014 Page 1 Crisis Management Plan The purpose of the Crisis Management plan is to define a step-by-step process to follow in the event

More information

Volunteer Registration Form

Volunteer Registration Form Volunteer Registration Form Entered by: Reviewed: : Today's : I. Personal Information Birth : Name: E-Mail: Address: Work Ph: ( ) City: Zip: Home Ph: ( ) May we contact you at work? Yes No Mobile Ph: (

More information

Student Transportation Policies and Procedures

Student Transportation Policies and Procedures Revised 7/19/12 Student Transportation Policies and Procedures Introduction The safety of our students at Wilmington University is very important. With this in mind, Wilmington University has instituted

More information

AGREEMENT FOR ADMISSION TO SANCTUARY CENTERS OF SANTA BARBARA RESIDENTIAL TREATMENT PROGRAM

AGREEMENT FOR ADMISSION TO SANCTUARY CENTERS OF SANTA BARBARA RESIDENTIAL TREATMENT PROGRAM AGREEMENT FOR ADMISSION TO SANCTUARY CENTERS OF SANTA BARBARA RESIDENTIAL TREATMENT PROGRAM 1. ( resident ), an individual, is admitted to Sanctuary Centers of Santa Barbara, Inc., (a California non-profit

More information

Kansas Speedway 400 Speedway Blvd Kansas City KS 66111 Ticket Office 913.328.3300 www.kansasspeedwaycorp.com COMING 70E

Kansas Speedway 400 Speedway Blvd Kansas City KS 66111 Ticket Office 913.328.3300 www.kansasspeedwaycorp.com COMING 70E Kansas Speedway 400 Speedway Blvd Kansas City KS 66111 Ticket Office 913.328.3300 www.kansasspeedwaycorp.com COMING 70E TAKE 435N EXIT 411B TO STATE AVE WEST EXIT 13B COMING 70W TAKE 435N EXIT 411B TO

More information

TEXAS A&M INTERNATIONAL UNIVERSITY

TEXAS A&M INTERNATIONAL UNIVERSITY AGREEMENT FOR WAIVER, INDEMNIFICATION, ASSUMPTION OF RISK AND MEDICAL TREATMENT AUTHORIZATION I,, age, desire to participate voluntarily in all activities of the ( Activity ), which is sponsored or conducted

More information

CLERY ACT CAMPUS SECURITY

CLERY ACT CAMPUS SECURITY CLERY ACT CAMPUS SECURITY 2015 ANNUAL SECURITY REPORT / CRIME STATISTICS Heritage College, Kansas City, Missouri 2012 2013 2014 CRIMINAL OFFENSES ON CAMPUS Burglary 0 0 0 Arrests for liquor law violations,

More information

Duke GEO Summer Program Participation Agreement

Duke GEO Summer Program Participation Agreement Duke GEO Summer Program Participation Agreement Summer Program Name: Term/Year: Student Full Name: Parent/Guardian Full Name: Student enrollment in Program is not granted until Student and a Parent/Guardian

More information

I UNDERSTAND THAT THESE RISKS MAY RESULT IN INJURY OR EVEN DEATH.

I UNDERSTAND THAT THESE RISKS MAY RESULT IN INJURY OR EVEN DEATH. CORNELL COLLEGE S RELEASE, WAIVER AND INDEMNIFICATION AGREEMENT FOR NON-EMPLOYEES ATTENDING FOR CREDIT ACTIVITIES OFFERED BY NON- EIIA MEMBER INSTITUTIONS OR OTHER THIRD PARTIES OR INDEPENDENT STUDY OR

More information

Amateur Sports Team & League Liability Insurance Application -No Participant Coverage-

Amateur Sports Team & League Liability Insurance Application -No Participant Coverage- Amateur Sports Team & League Liability Insurance Application -No Participant Coverage- Name of Organization: C/O (Individual Responsible for Insurance): Mailing : City: State: Zip: Phone: ( ) Fax: ( )

More information

North Dakota College Tour

North Dakota College Tour North Dakota College Tour University of North Dakota North Dakota State University Minnesota State University, Moorhead Friday, October 31 - Saturday, November 1, 2014 Open to Sophomores, Juniors, and

More information

CONSENT TO PARTICIPATE IN SCHOOL-SPONSORED SPORTS

CONSENT TO PARTICIPATE IN SCHOOL-SPONSORED SPORTS CONSENT TO PARTICIPATE IN SCHOOL-SPONSORED SPORTS THIS FORM CONTAINS THE CONDITIONS UNDER WHICH YOUR CHILD MAY PARTICIPATE IN THE STRATFORD SCHOOL SPORTS PROGRAM(S). PLEASE ENSURE YOU READ IT CAREFULLY

More information

CSU Sport Clubs Resource Guide

CSU Sport Clubs Resource Guide CSU Sport Clubs Resource Guide Table of Contents Page # Introduction 1 Definitions 3 Using this Guide: Tips for the Sport Clubs Administrator 6 Minimum Requirements: Summary 7 Sport Clubs Program Assessment

More information

Section I: USA Gymnastics Membership Requirements New additions are highlighted

Section I: USA Gymnastics Membership Requirements New additions are highlighted I. Athlete Membership Section I: USA Gymnastics Membership Requirements New additions are highlighted All athletes appearing in a USA Gymnastics sanctioned event must be pre-registered athlete members

More information

Omega Delta National Fraternity, Inc. Risk Management Policy 2015 v1.2

Omega Delta National Fraternity, Inc. Risk Management Policy 2015 v1.2 OMEGA DELTA NATIONAL FRATERNITY, INC. Omega Delta National Fraternity, Inc. Risk Management Policy 2015 v1.2 TABLE OF CONTENTS ALCOHOL AND DRUGS POLICY ANTI HAZING POLICY SEXUAL ABUSE AND HARASSMENT POLICY

More information

Kendall United/Kendall Soccer Coalition 2014-2015 Season Member Registration Package (Competitive Teams Ages U9-U18) INFORMED CONSENT/INSURANCE NOTICE

Kendall United/Kendall Soccer Coalition 2014-2015 Season Member Registration Package (Competitive Teams Ages U9-U18) INFORMED CONSENT/INSURANCE NOTICE Kendall United/Kendall Soccer Coalition 2014-2015 Season Member Registration Package (Competitive Teams Ages U9-U18) Did you play for Kendall United last year? Yes No Member s Last Name: Member s First

More information

Table A. Characteristics of Respondents that completed the survey

Table A. Characteristics of Respondents that completed the survey Table A. Characteristics of Respondents that completed the survey Characteristic Category Weighted Un- weighted Number % Number % Age 18 years old 4,111 8.8 700 8.4 19 years old 8,605 18.3 1,421 17.0 20

More information

TSF Player Invitation Inter Academy Program U9-U12 Boys & Girls

TSF Player Invitation Inter Academy Program U9-U12 Boys & Girls TSF Player Invitation Inter Academy Program U9-U12 Boys & Girls TSF Academy would like to extend an invitation to play soccer with our Inter Academy Program. We are very excited about the upcoming season.

More information

Barstow Judo Club Invitational Judo Tournament

Barstow Judo Club Invitational Judo Tournament Barstow Judo Club Invitational Judo Tournament Date: Sunday June 24, 2012 Location: Eligibility: Entry Fee: Awards: Sanction: Cora Harper Community Center 841 Barstow Road Barstow, CA 92311 MUST BE Current

More information

Potomac State College -ALCOHOL AND DRUG POLICIES

Potomac State College -ALCOHOL AND DRUG POLICIES Potomac State College -ALCOHOL AND DRUG POLICIES WVU Board of Governors Policy 18: Alcoholic Beverages on the Campuses Student Conduct Code Residence Hall Policies Relating to Alcohol and Drugs (see page

More information

State University of New York College at Old Westbury. Domestic Violence and the Workplace Policy

State University of New York College at Old Westbury. Domestic Violence and the Workplace Policy State University of New York College at Old Westbury Domestic Violence and the Workplace Policy Policy Statement The persons covered by this policy are: employees of SUNY College at Old Westbury (the College

More information

UNIVERSITY OF HOUSTON STUDY ABROAD PROGRAM ACTIVITIES PARTICIPANT S RELEASE AND WAIVER OF LIABILITY AGREEMENT (Form A1) I. RELEASE

UNIVERSITY OF HOUSTON STUDY ABROAD PROGRAM ACTIVITIES PARTICIPANT S RELEASE AND WAIVER OF LIABILITY AGREEMENT (Form A1) I. RELEASE UNIVERSITY OF HOUSTON STUDY ABROAD PROGRAM ACTIVITIES PARTICIPANT S RELEASE AND WAIVER OF LIABILITY AGREEMENT (Form A1) This Release and Waiver of Liability Agreement is entered into by all Participants

More information

Please type or print. Name: Last First Middle. Program: For Participants in State University of New York Administered Overseas Academic Activities

Please type or print. Name: Last First Middle. Program: For Participants in State University of New York Administered Overseas Academic Activities AGREEMENT AND RELEASE FOR STUDY ABROAD STATE UNIVERSITY OF NEW YORK Overseas Academic Programs Please type or print. Name: Last First Middle Program: Location Abroad Term Abroad For Participants in State

More information

DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP:

DATE OF BIRTH: STREET ADDRESS: CITY/STATE/ZIP: Get Noticed Beach Volleyball Waiver WAIVER AND RELEASE, EXPRESS ASSUMPTION OF RISK, INDEMNITY AND HOLD HARMLESS AGREEMENT, AND GRANT OF RIGHTS NAME OF PLAYER: PLAYER AGE DATE OF BIRTH: PLAYER GRADE as

More information

All Students - Please complete items 1-5 All paperwork must have original signatures and be readable. No partial submissions will be accepted.

All Students - Please complete items 1-5 All paperwork must have original signatures and be readable. No partial submissions will be accepted. Independent Study Physical Education (I.S.P.E.) The following items must be on file before your Independent Study application is complete. (1) Complete the online I.S.P.E. contract (keep a copy for your

More information

SANTA BARBARA SCHOOL DISTRICTS, SECONDARY EDUCATION INDEPENDENT STUDY PHYSICAL EDUCATION. HOLD HARMLESS AGREEMENT (Agency/Instructor/Coach)

SANTA BARBARA SCHOOL DISTRICTS, SECONDARY EDUCATION INDEPENDENT STUDY PHYSICAL EDUCATION. HOLD HARMLESS AGREEMENT (Agency/Instructor/Coach) SANTA BARBARA SCHOOL DISTRICTS, SECONDARY EDUCATION INDEPENDENT STUDY PHYSICAL EDUCATION HOLD HARMLESS AGREEMENT (Agency/Instructor/Coach) (Agency/Instructor/Coach) hereby agrees to defend, indemnify and

More information

WAIVER AND RELEASE PACKET

WAIVER AND RELEASE PACKET Study Abroad Office One Bernard Baruch Way, Box J-0810 New York, NY 10010 Phone:+1 646 312 2091 Fax: +1 646 312 2071 e-mail: study.abroad@baruch.cuny.edu CUNY-SPONSORED INTERNATIONAL TRAVEL WAIVER AND

More information

McKendree University. Office of Greek Life. Risk Management Policy

McKendree University. Office of Greek Life. Risk Management Policy McKendree University Office of Greek Life Risk Management Policy I. General Policies ALCOHOL AND DRUGS A. The possession, sale, use or consumption of ALCOHOLIC BEVERAGES, while on chapter premises or during

More information

What is DOMESTIC VIOLENCE?

What is DOMESTIC VIOLENCE? What is DOMESTIC VIOLENCE? Domestic violence is a pattern of control used by one person to exert power over another. Verbal abuse, threats, physical, and sexual abuse are the methods used to maintain power

More information

MOUNTLAKE TERRACE POLICE DEPARTMENT GUEST RIDE-ALONG POLICY AND APPLICATION

MOUNTLAKE TERRACE POLICE DEPARTMENT GUEST RIDE-ALONG POLICY AND APPLICATION MOUNTLAKE TERRACE POLICE DEPARTMENT GUEST RIDE-ALONG POLICY AND APPLICATION In keeping with its commitment to community policing, the Mountlake Terrace Police Department offers qualified persons the opportunity

More information

TARLETON SPORTS MEDICINE. Student-Athlete Medical Information

TARLETON SPORTS MEDICINE. Student-Athlete Medical Information TARLETON SPORTS MEDICINE Student-Athlete Medical Information TARLETON STATE UNIVERSITY ATHLETICS DEPARTMENT Box T-0080 Stephenville, TX 76402 254-968-9178 254-968-9674 FAX www.tarletonsports.com Dear Parent

More information

THE GYM, LLC MEMBERSHIP AGREEMENT

THE GYM, LLC MEMBERSHIP AGREEMENT Member s Name: THE GYM, LLC MEMBERSHIP AGREEMENT For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the undersigned ( Member ) and THE GYM, LLC, a Colorado

More information

SEXUAL ASSAULT POLICY

SEXUAL ASSAULT POLICY SEXUAL ASSAULT POLICY California State University, Stanislaus is strongly committed to the establishment of an educational environment in which students, faculty, and staff can work together in an atmosphere

More information

PLEASE READ ALL INFORMATION CAREFULLY

PLEASE READ ALL INFORMATION CAREFULLY Eligibility and Application Information Global Scholars Study Abroad Program 2016 SERVICE LEARNING Costa Rica and Nicaragua PLEASE READ ALL INFORMATION CAREFULLY Travel Dates: April 25 - May 6, 2016 (Dates

More information

SUMMARY OF INSURANCE COVERAGE FOR ISI HOCKEY MEMBERS Policy Year 9/1/14 to 8/31/15

SUMMARY OF INSURANCE COVERAGE FOR ISI HOCKEY MEMBERS Policy Year 9/1/14 to 8/31/15 SUMMARY OF INSURANCE COVERAGE FOR ISI HOCKEY MEMBERS Policy Year 9/1/14 to 8/31/15 A. GENERAL LIABILITY Provides comprehensive general liability insurance with a $1,000,000 occurrence limit, with a $2,000,000

More information

UNIVERSITY OF CONNECTICUT UNDERGRADUTE EDUCATION FIELD TRIP POLICY

UNIVERSITY OF CONNECTICUT UNDERGRADUTE EDUCATION FIELD TRIP POLICY Field Trips are an important component of the experiential learning advocated in the University s academic plan for undergraduate education. In order to promote the success and safety of all involved in

More information

Garrett Middle School Athletic Handbook 2015-16

Garrett Middle School Athletic Handbook 2015-16 Garrett Middle School Athletic Handbook 2015-16 1 Athletic Department Philosophy It is the intent of Garrett Middle School to encourage and allow athletic participation while maintaining academic integrity

More information

Santa Barbara Unified School District Independent Study Physical Education (ISPE) Criteria and Guidelines

Santa Barbara Unified School District Independent Study Physical Education (ISPE) Criteria and Guidelines Criteria and Guidelines To qualify for ISPE a student must have a Grade Point Average (GPA) of 2.0 and no conduct violations. In addition, the student must meet the following criteria: The student is an

More information

FACILITIES USE AGREEMENT

FACILITIES USE AGREEMENT FACILITIES USE AGREEMENT Effective Date: Sponsor: Sponsor Address: Facility: THIS FACILITIES USE AGREEMENT ( Agreement ) is effective as of the Effective Date set forth above, by and between Temple University

More information

WHEREAS, Participants desire to participate in ALL the recreational activities available at the Trampoline Park; and

WHEREAS, Participants desire to participate in ALL the recreational activities available at the Trampoline Park; and THIS PARTICIPATION AGREEMENT is made and effective as of the last date executed (hereinafter the "Effective Date") by and between Get Air Savannah (hereinafter "Get Air") and the adult or guardian identified

More information

Taishi Judo Club 5 th Annual Invitational Tournament

Taishi Judo Club 5 th Annual Invitational Tournament Taishi Judo Club 5 th Annual Invitational Tournament Date/Time: Location: Sunday, March 22, 2015. Tournament will start promptly at 10:00AM Northview High School 1016 W. Cypress St. Covina, CA 91722 Sanction:

More information

Self-Help Guide for a Prosecutorial Discretion Request

Self-Help Guide for a Prosecutorial Discretion Request Self-Help Guide for a Prosecutorial Discretion Request In June 2011, Immigration and Customs Enforcement ( ICE ) announced it would not use its resources to deport people it considers low priority and

More information

~LOTUS GUNWORKS OF SOUTH FLORIDA, LLC~ RELEASE, WAIVER, INDEMNIFICATION, HOLD HARMLESS, AND ASSUMPTION OF THE RISK AGREEMENT

~LOTUS GUNWORKS OF SOUTH FLORIDA, LLC~ RELEASE, WAIVER, INDEMNIFICATION, HOLD HARMLESS, AND ASSUMPTION OF THE RISK AGREEMENT ~LOTUS GUNWORKS OF SOUTH FLORIDA, LLC~ RELEASE, WAIVER, INDEMNIFICATION, HOLD HARMLESS, AND ASSUMPTION OF THE RISK AGREEMENT WHEREAS, in return for being allowed to enter Lotus Gunworks, Lotus Gun Range

More information

Truett-McConnell Athletic Training Forms

Truett-McConnell Athletic Training Forms Truett-McConnell Athletic Training Forms Table of contents 1. Welcome letter 2. Assumption of Risk and Consent to Treat 3. Authorization/Consent for Disclosure of Protected Health Information (PHI) 4.

More information

American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016

American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016 American Football Association, Inc. Endorsed General Liability Insurance Program Available: January 1, 2015 to January 1, 2016 This insurance program is available for amateur teams & leagues that are members

More information