TEXAS A&M UNIVERSITY-COMMERCE WAIVER PACKET
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1 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 the MRC for General Use, each participant must also complete the Campus Recreation Waiver. 3. ROCK WALL (MRC) WAIVER If you camp is utilizing the MRC Rockwall, each participant must also complete the MRC Rockwall waiver. For questions or concerns regarding these waivers, please contact the summer camp office, (903) or For additional information, please visit
2 WAIVER, INDEMNIFICATION, AND MEDICAL TREATMENT AUTHORIZATION FORM 1. EXCULPATORY CLAUSE. In consideration for receiving permission to participate in any and all activities of (herein referred to as activity ), which is sponsored by Texas A&M University-Commerce, summer camps (herein referred to as sponsor ), a member of The Texas A&M University System, I hereby release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes sponsor, The Texas A&M University System, the Board of Regents for The Texas A&M University System, and their members, officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES or INDEMNITEES) from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, that may be sustained by me while participating in such activity, while traveling to and from the activity, or while on the premises owned or leased by RELEASEES, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. 2. INDEMNITY CLAUSE. I am fully aware that there are inherent risks to myself and others involved with this activity and I choose to voluntarily participate in said activity with full knowledge that the activity may be hazardous to me and my property, and to the person and property of others. I acknowledge there may be physically strenuous activities. I know of no medical reason why I should not participate. I agree to indemnify and hold harmless INDEMNITEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, which may occur to myself, other participants, and third-persons as a result of my participation in said activity, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of INDEMNITEES. 3. NO INSURANCE. I understand that RELEASEES do not maintain any insurance policy covering any circumstance arising from my participation in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. Sponsor does not carry general liability insurance to cover claims arising from this activity so it seeks a waiver of claims as additional consideration for the right to participate so sponsor, a governmental unit of the State of Texas, can (a) provide the activity at the lowest possible cost to participants; and (b) provide access to a greater number of participants by expending limited resources on program materials rather than on liability insurance. 4. BINDS HEIRS. It is my express intent that this agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be governed by the laws of the State of Texas. 5. MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, and WAIVER. I understand RELEASEES cannot be expected to control all of the risks articulated in this form and RELEASEES may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required, as determined by a medical professional at the medical facility, during my participation in this activity with the understanding that the cost of any such treatment will be my responsibility. I agree to indemnify and hold harmless INDEMNITEES for any costs incurred to treat me, even if an INDEMNITEE has signed hospital documentation promising to pay for the treatment due to my inability to sign the documentation. I further agree to release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes, RELEASEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, that may be sustained by me while receiving 1of 2
3 medical care or in deciding to seek medical care, including while traveling to and from a medical care facility, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. 6. VOLUNTARY SIGNATURE. In signing this agreement I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; sponsor has not made and I have not relied on any oral representations, statements, or inducements apart from the terms contained in this agreement. I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future. For students engaging in extracurricular activities: I understand I can choose not to sign this document and free myself from its terms and the associated risks of the activity by simply not participating in the activity and choosing some other activity available to me that has a lower level of risk to me. I further understand this is a voluntary, extracurricular activity; therefore it is not required for me to obtain college credits and not participating in this activity will in no way hinder my ability to obtain a degree from the university. For students going on fieldtrips or other class-related activities: I understand participation in this class/fieldtrip/activity is not mandatory and I will not be penalized for failing to participate in this activity because an alternative activity exists for which I can receive like credit. While I understand alternative activities are available to me that do not have the risks associated with this activity I still desire to voluntarily engage in this activity. SIGNING THIS DOCUMENT INVOLVES THE WAIVER OF VALUABLE LEGAL RIGHTS. CONSULT YOUR ATTORNEY BEFORE SIGNING THIS DOCUMENT. SIGNED this day of, 20 Participant Signature: Printed Name: Participant s Date of Birth: Parent or Legal Guardian Signature: (If Participant is under 18 years old) Parent or Legal Guardian Printed Name: (If Participant is under 18 years old) 2of 2
4 CHECK WHERE APPROPRIATE Membership Purchase: Daily Guest Pass: Intramural/Facility Visitor: Summer Camp: vhn T E X A S A & M U N I V E R S I T Y C O M M E R C E A Member of The Texas A&M University System ASSUMPTION OF RISK, MEDICAL RELEASE, AND INDEMNIFICATION FORM 1. EXCULPATORY CLAUSE. In consideration for receiving permission to participate in any and all activities of Campus Recreation (herein referred to as activity ), which is sponsored by Texas A&M University - Commerce (herein referred to as sponsor ), a member of The Texas A&M University System, I hereby release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes sponsor, The Texas A&M University System, the Board of Regents for The Texas A&M University System, and their members, officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES or INDEMNITEES) from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, that may be sustained by me while participating in such activity, while traveling to and from the activity, or while on the premises owned or leased by RELEASEES, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. 2. INDEMNITY CLAUSE. I am fully aware that there are inherent risks to myself and others involved with this activity, including but not limited to Injury or Death, and I choose to voluntarily participate in said activity with full knowledge that the activity may be hazardous to me and my property, and to the person and property of others. I acknowledge there may be physically strenuous activities. I know of no medical reason why I should not participate. I agree to indemnify and hold harmless INDEMNITEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, which may occur to myself, other participants, and third-persons as a result of my participation in said activity, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of INDEMNITEES. 3. NO INSURANCE. I understand that RELEASEES do not maintain any insurance policy covering any circumstance arising from my participation in this activity or any event related to that participation. As such, I am aware that I should review my personal insurance coverage. Sponsor does not carry general liability insurance to cover claims arising from this activity so it seeks a waiver of claims as additional consideration for the right to participate so sponsor, a governmental unit of the State of Texas, can (a) provide the activity at the lowest possible cost to participants; and (b) provide access to a greater number of participants by expending limited resources on program materials rather than on liability insurance. 4. BINDS HEIRS. It is my express intent that this agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representatives, if I am deceased, and shall be governed by the laws of the State of Texas.
5 5. MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, and WAIVER. I understand RELEASEES cannot be expected to control all of the risks articulated in this form and RELEASEES may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required, as determined by a medical professional at the medical facility, during my participation in this activity with the understanding that the cost of any such treatment will be my responsibility. I agree to indemnify and hold harmless INDEMNITEES for any costs incurred to treat me, even if an INDEMNITEE has signed hospital documentation promising to pay for the treatment due to my inability to sign the documentation. I further agree to release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes, RELEASEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, that may be sustained by me while receiving medical care or in deciding to seek medical care, including while traveling to and from a medical care facility, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. 6. VOLUNTARY SIGNATURE. In signing this agreement I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; sponsor has not made and I have not relied on any oral representations, statements, or inducements apart from the terms contained in this agreement. I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future. For students engaging in extracurricular activities: I understand I can choose not to sign this document and free myself from its terms and the associated risks of the activity by simply not participating in the activity and choosing some other activity available to me that has a lower level of risk to me. I further understand this is a voluntary, extracurricular activity; therefore it is not required for me to obtain college credits and not participating in this activity will in no way hinder my ability to obtain a degree from the university. SIGNING THIS DOCUMENT INVOLVES THE WAIVER OF VALUABLE LEGAL RIGHTS. CONSULT YOUR ATTORNEY BEFORE SIGNING THIS DOCUMENT. SIGNED this day of, 20. Participant Signature: Printed Name: Participant s Date of Birth: Parent or Legal Guardian Signature: (If Participant is under 18 years old) Parent or Legal Guardian Printed Name: (If Participant is under 18 years old) INSTRUCTIONS: (1) The document should be printed in a font size no smaller than 10-point type. This is 10-point type. This is 12-point type. (2) The formatting/font style (bolded, underlined, and italicized) in paragraph nos. 1, 2, 5 & 6 should not be altered. TAMUS-OGC-Approved 08/29/2006 Page 2 of 2
6 Waiver, Indemnification and Medical Treatment Authorization Form Last Name: In consideration for receiving permission for myself or my dependent to participate at the indoor climbing facility at the Morris Recreation Center at Texas A&M University - Commerce, and/or participate in any program offered, including academic classes, I agree to the following waiver and release and make the following representations: I HEREBY ACKNOWLEDGE THE INHERENT EXTREME RISKS IN ROCK CLIMBING, including climbing on artificial surfaces. I acknowledge there may be physically strenuous activities. I know of no medical reason why I should not participate. I realize that those risks include, but are not limited to: Equipment may fail, malfunction or be used incorrectly. Rope burns while handling the rope. Falling to the ground from a height of varying distances. During a fall on top rope or lead, the jolt from the rope catching you may injure you. Objects falling off the climbing site may hit you such as climbing holds, bolts, climbing equipment and even other people. Anchors may fail. Belayer error Slipping and falling at the climbing site Bad decision making Inattention of belayers or actions of other climbers Misuse or failure of equipment Holds which may become loose or damaged Personal injury including but not limited to: blisters, sprains, strains, dislocations, torn muscles, and/or ligaments; fractured or broken bones; eye damage; cuts, wounds, scrapes, abrasions and/or contusions; head, neck, and/or spinal injuries; medical illnesses; allergic reaction, shock, paralysis or death and serious injury or impairment to other aspects of my body and general health and well being. And accidents which cannot be foreseen I acknowledge that the above list is not inclusive of all possible risks associated with the use of the facilities, and/or the sport of climbing and I agree that said list in no way limits the extent or reach of this release. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY AND ALL LIABILITES, RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me as a result of participating in said activity including injuries sustained as a result of the sole, joint or concurrent negligence, NEGLIGENCE PER SE, STATUTORY FACULT OR STRICT LIABILITY of The Texas A&M University System, the Board of Regents for The Texas A&M University System, and their officers, servants, agents, volunteers, or employees (herein referred to as RELEASEES or INDEMNITEES) I know of no medical reason why I should not participate in this activity. I voluntarily participate in this activity with the full knowledge that the activity may be hazardous to me and my property, and to the person and property of others, and agree to assume all risk of personal injury, including paralysis and death, that may be sustained by me while I am in the facility, whether or not under supervision of Texas A&M University- Commerce personnel. I hereby knowingly and intentionally waive, discharge, covenant not to sue, and agree to indemnify, hold harmless and defend Texas A&M University Commerce, its successors, assigns, officers and employees, INDEMNITEES, and wall designer and builders, hold manufactures, affiliated organizations and agents from all liabilities, claims, demands, injuries (including paralysis or death), including court costs and attorney s fees and expenses, which may occur to myself, other participants and third- persons as a result of my participation in this activity, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. I am in good health and have no physical limitations which would affect my safe use of the facilities. I agree to pay attention to the state of any ropes, anchors and other climbing equipment I may use, and to advise staff members if I do damage or notice any damage. I certify that I have read the posted rules, and I agree to abide by these rules and any further rules, and if staff makes a specific request or instruction to me, I agree to comply. I understand that indoor climbing is not the same as outdoor climbing, which requires additional skills. I agree to seek qualified instruction before attempting to climb outdoors.
7 Last Name: MEDICAL AUTHORIZATION, INDEMNITY FOR MEDICAL EXPENSES, and WAIVER. I understand RELEASEES cannot be expected to control all of the risks articulated in this form and RELEASEES may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required, as determined by a medical professional at the medical facility, during my participation in this activity with the understanding that the cost of any such treatment will be my responsibility. I agree to indemnify and hold harmless INDEMNITEES for any costs incurred to treat me, even if an INDEMNITEE has signed hospital documentation promising to pay for the treatment due to my inability to sign the documentation. I further agree to release, waive, discharge, covenant not to sue, and agree to hold harmless for any and all purposes, RELEASEES from any and all liabilities, claims, demands, injuries (including death), or damages, including court costs and attorney s fees and expenses, that may be sustained by me while receiving medical care or in deciding to seek medical care, including while traveling to and from a medical care facility, including injuries sustained as a result of the sole, joint, or concurrent negligence, negligence per se, statutory fault, or strict liability of RELEASEES. I understand this waiver does not apply to injuries caused by intentional or grossly negligent conduct. I authorize Outdoor Adventures, Department of Recreational Sports and Texas A&M University Commerce and its agents to photograph, videotape, audio record, televise, duplicate, and/or otherwise record my image, voice, and likeness. I understand that Outdoor Adventures, Department of Recreational Sports and Texas A&M University Commerce will own these recordings. I irrevocably authorize Outdoor Adventures, Department of Recreational Sports and Texas A&M University Commerce and its agents to use, display, publish, and distribute these recordings for any purpose on websites, publications, broadcasts, displays, and any other medium, and to offer these recordings to others for use in non- university mediums. I waive any right to inspect or approve these recordings or material that may be used with them now or in the future, whether that use is known to me or not. I release Outdoor Adventures, Department of Recreational Sports and Texas A&M University Commerce, its regents, employees, and agents from all liability arising out of the use of these recordings, including but not limited to any claims arising out of my right of privacy or right of publicity and any claims based on any distortions, optical illusions, or faculty mechanical reproductions. I understand that I will not be compensated for any use of these recordings. VOLUNTARY SIGNATURE. In signing this agreement I acknowledge and represent that I have read it, understand it, and sign it voluntarily as my own free act and deed; sponsor has not made and I have not relied on any oral representations, statements, or inducements apart from the terms contained in this agreement. I execute this document for full, adequate and complete consideration fully intending to be bound by the same, now and in the future. For students engaging in extracurricular activities: I understand I can choose not to sign this document and free myself from its terms and the associated risks of the activity by simply not participating in the activity and choosing some other activity available to me that has a lower level of risks to me. I further understand this is a voluntary, extracurricular activity; therefore it is not required for me to obtain college credits and not participating in this activity will in no way hinder my ability to obtain a degree from the university. This release shall be effective and binding upon me and my spouse (if any), if I am alive, and assigns, heirs, representatives, executors, and administrators if I am deceased, and shall be governed by the laws of the State of Texas. SIGNING THIS DOCUMENT INVOLVES THE WAIVER OF VALUABLE LEGAL RIGHTS. CONSULT YOUR ATTORNEY BEFORE SIGNING THIS DOCUMENT. No oral representations, statements or inducements apart from the above written agreement have been made. I expressly state that I have read, understand and am familiar with all its provisions and that I sign it of my own free will. I further expressly agree that this release, waiver and indemnification agreement is intended to be as broad and inclusive as is permissible by the laws of the State of Texas and that if any portion of this agreement is held to be invalid, it is agreed that the balance shall, notwithstanding, continue in full force and effect.
8 MUST BE COMPLETELY FILLED IN Last Name: Participant Legal Printed Name Date of Birth Age Address City State Home Phone Work Phone Emergency Contact Relationship Phone Participant s Signature Date TO BE READ AND SIGNED BY A PARENT/LEAGAL GUARDIAN OF A PARTICIPANT (If Participant is under 18 years old) I hereby state that I am the parent/legal guardian of the Participant whose signature appears above. I am familiar with and consent to the terms and provisions set forth in this waiver. Parent/legal Guardian s Printed Name Date Parent/legal Guardian s Signature Texas A&M University- Commerce Campus Recreation Department- Morris Recreation Center- Commerce, Texas commerce.edu/reccenter/
9 Last Name: GROUND SCHOOL CHECK- OFF After completion of the ground school and demonstration of the necessary skills, an instructor will examine your skill set to belay at the indoor climbing facility. Please PRINT legibly: has successfully completed the ground school. 1) Read and understood the posted Rules and Regulations 2) Demonstrated proper use of equipment and procedures 3) Demonstrated competent tying of the Figure 8 knot 4) Proper belaying and lowering techniques 5) Proper use and wear of the harness 6) Proper use of commands 7) Proper spotting technique for bouldering I, acknowledge that I am proficient in the above practices, and that I understand and will abide by the Rules and Regulations posted. I have also read and signed a waiver and understand the nature of the sport of climbing. Signature: Date Climbing Instructor (Please Print): Pass Fail Date Comments from instructor:
TEXAS A&M INTERNATIONAL UNIVERSITY
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