Club Sport Coach/Instructor Agreement, Risk Acknowledgement and Liability Waiver This Agreement is in effect from August 1, 2010 - July 31, 2011 Approved Club Sport: (hereinafter referred to as Club Sport or Club ) It is understood by all parties that this is a sports activity club, governed primarily by the club members, and will involve competitions against other players and colleges and will involve periodic travel which may include personal vehicles. Club Sports carry risks inherent that are typical of all sports activities, and despite any precautions taken, not all risks can be prevented, including a high risk of injury and other risks as follows: Risk Acknowledgement of Club Sports Participation: I understand that my Coach/Instructor participation with Club Sports, and the travel associated with it, could involve risk of bodily injury, property damage, or death, and I accept and understand these risks. I acknowledge that it is the responsibility of each Coach/Instructor to participate only in those activities of which he/she is physically capable, and understand that I may decline to do any activity at any time. Risks inherent to Club Sports Activities may include but are not limited to the following: Any risks inherent in participating in any type of sport; any type of travel; use of vehicles or vessels associated with the club sport; vehicle accidents; sports play accidents; collision with players, sports equipment, structures, or vessels; violence or mental instability; weather conditions; unavailable healthcare facilities or assistance; inadequate or faulty equipment; inappropriate equipment; lack of equipment; inappropriate use of equipment; exposure to outdoors, nature, or bodies of water; lack of knowledge and/or negligence of others or self; and/or mistakes. I understand and acknowledge that these risks, related to any club sports activities, may result in personal injury, including but not limited to the following, depending upon club type and activities: Slips/trips/falls; fractures/broken bones; sprains/strains; bruises; lacerations; punctures; gun-related wounds; concussion; loss of consciousness; exhaustion; sunburn/windburn; sun poisoning; drowning; skin cancer; eye injuries; bites/stings/burns/rashes from contact with animals, nature or sea life; shark attack; spinal injuries; paralysis; brain damage; serious injury to internal organs, bones, ligaments, joints, muscles, tendons, and other aspects of the muscular skeletal system; injuries to the neck, face, eye, ear and head; heart attack; sickness; and/or death. Insurance: I understand that as a non-employee, the University does not provide health insurance, auto insurance, or workers compensation coverage to volunteers or independent contractors, and understand that I am responsible for obtaining and sustaining my own health/medical or auto insurance coverage. I acknowledge that any accident insurance coverage that the University may carry applicable to unpaid volunteers would be secondary and excess to all other applicable insurance policies, including, but not limited to any health care and auto insurance coverages I may have. I acknowledge that upon execution of this written agreement, and approval and initiation of my Club Sports services, the University s liability umbrella will extend coverage to Club Sports Coaches/Instructors in connection to their agreed upon services, as applicable to the University s liability insurance policies and terms. Emergency Medical Treatment: Should I become injured or ill during my Coach/Instructor activities, I hereby grant Stetson University full authority to obtain emergency medical services for me at their discretion, or if I am unable to; and I accept responsibility for any related costs thereof, and release the University and their related staff, representatives or host organizations from liability for such decisions.
Club Sports Services: For value received, and upon signing and submitting this Club Sport Acknowledgement and Waiver, I acknowledge and confirm that my services at Stetson University, Inc. ( the University ) are voluntarily offered, and are rendered to assist with the general activities of the named Club Sport above, as described in the Club Sports Coach/Instructor guidelines and responsibilities attached. I furthermore agree to abide by Stetson University policies and procedures, as well as all state, federal, and local laws. I also understand that if my services at Stetson University are unpaid and voluntary, either the University or I may terminate them at any time, with or without cause. Coach/Instructor Campus Benefits: Your status as a University Club Sports Coach/Instructor will entitle you to: A temporary University identification card;* Access to the Hollis Center, Library & Cafeteria* and Reasonable use of related equipment and materials* (* Subject to revocation or cancellation at the sole discretion of the University) I acknowledge and understand that any decision made in regards to my services and any monetary compensation and/or reimbursement for expenses is solely with the Club Members. I therefore acknowledge that if I receive any monetary compensation, I am considered an Independent Contractor and not an employee of Stetson University, Inc. while performing Club Sports Coach/Instructor services, and am therefore not entitled to any employee benefits such as; medical, retirement, life, or workers compensation from Stetson University, Inc. If I should receive any paid compensation or reimbursement for expenses, I understand and agree to the following: I am being paid as an Independent Contractor, not an employee, and must complete and submit a W-9/Accounts Payable Form I acknowledge and agree that neither Federal, State nor Local Taxes of any kind shall be withheld or paid by Stetson on my behalf, and that I shall not be treated as an employee of Stetson with respect to the services performed hereunder for Federal or State Tax purposes. I acknowledge and understand that, as an Independent Contractor, it is my responsibility to pay, according to law, my own income tax and understand that as an individual, I may be liable for self employment, social security, and other such taxes as per the law. I agree to hold Stetson University, Inc. harmless and indemnify it from any causes of action resulting from my negligence in the execution of said taxes. I agree to give 2 weeks notice if I cannot fulfill my Coach/Instructor services for the academic year as agreed upon. I further understand that my services may be terminated, with or without cause or notice by the Club Officers, the Coordinator of Club Sports or the Senior Associate Athletic Director of Stetson University. If either I or the University should terminate my services, I will be compensated for services that have already been rendered on a prorated basis at the discretion of the University Club Sports Administrators. Coaching/Instructor Services Agreed Upon Payment: * (To be paid in 2 installments) Installment Amount: / Fall Semester Date: Spring Semester Date: *I understand that pay advances cannot be granted. Background Screens: (Must be completed and approved prior to start of any Coach/Instructor services) I acknowledge that the University will conduct the same standard background investigation for volunteer or contracted coaches as is conducted for all individuals that may have direct contact with students, and authorize them to do so upon completion of the attached background information release form. I understand that since driving may be part of my services as a Club Sports Coach, Stetson University requires that I must maintain an acceptable driving record and valid Florida driver s license, and will agree to show proof of both upon signing this document. Therefore, upon signing the attached background information release form, I authorize the University to access my driving record as part of the background screening process.
Confidentiality: I acknowledge, that during my services as a Coach/Instructor, that I might have access to, or be exposed to confidential information of Stetson University or the Club which may include, but not limited to; social security numbers, addresses, telephone numbers, files, correspondence, health or personal information, as well as conversations, electronic records, emails, data bases and recordings. I acknowledge that disclosure of such information could cause irreparable harm or damage to Stetson University, its employees and/or students. I therefore agree that I shall keep confidential and not disclose any information acquired from Stetson University, its staff, students, agents, or representatives in connection with this agreement or services, and any such information shall only be used in the performance of services as set forth herein and for no other purpose. I acknowledge and agree that my obligation to maintain confidentiality does not expire and remains in effect even after my agreement for services has expired. General Provisions: A. This Agreement is to be governed by the laws of the State of Florida. Venue for any action arising hereunder will be exclusively in Volusia County, Florida. B. This Agreement contains the entire agreement between the parties, and any agreement to amend or modify this lease will be ineffective unless it is in writing and signed by both parties. Liability Waiver and Indemnification: Furthermore, in consideration of the opportunity afforded me, with full knowledge and appreciation of the risks involved, I hereby agree to indemnify, release and hold harmless; Stetson University, Inc., its faculty, staff, trustees, officers, representatives, chaperones, volunteers, players, agents, participants and off-campus host organizations from all form and manner of risks inherent or relating to such Club Sports activities, and I waive all claims and demands of any nature arising from said Coach/Instructor participation and services. I agree and understand that this liability waiver and indemnification will extend beyond the dates of this agreement. I hereby acknowledge that I have had the opportunity to review this form and have it reviewed by legal counsel if necessary. I understand the foregoing and hereby agree to be bound by same. Signature of Coach/Instructor: Date: Print Full Legal Name of Coach/Instructor Signature of Witness Printed Name: (Date) Coach/Instructor Phone Contacts: Address: Email: Emergency Contact Info:
Club Sports Coach/Instructor Agreement & Responsibilities As a coach/advisor of this club, I acknowledge the following: In the capacity as a Club Sports coach/instructor, I understand I am an independent contractor or volunteer of the University s club sports program and not an employee of Stetson University. (Qualified current employees of Stetson may serve as a coach in a non-employee capacity). I have a firm grasp of the sport s basics, understand safe conditioning and training methods, can relate to the club members, and will become familiar with and adhere to the policies and procedures of the Club Sport program and will encourage club members to do the same. I understand that Club Sports are directed and governed by students, therefore, I acknowledge and respect the leadership positions of the officers and agree to abide by those club decisions made on behalf of the group. I understand that recommendations made by myself are encouraged and will be considered by the group; but ultimately the final decisions rest with the club members and officers. Additionally I shall: Be a positive role model for all participants Help develop leadership qualities of club officers and continuity between new and outgoing officers Encourage positive team-building activities Act as positive critic to club operations and serve as a resource for alternative ideas and solutions Assist officers in scheduling activities, practices, and purchasing of equipment and maintenance Assist officers in setting goals that are attainable, realistic, and challenging Provide supervision, expertise, and mature judgment Develop and improve sport skills in a safe and organized manner Encourage talk with group about how performance can be improved during competition and practices Monitor performance for evaluating skill levels for recognition or assignment of competitive entries Attend club meetings when deemed necessary Be familiar with club business transactions Monitor conduct of participants to help ensure activities of the club reflect favorably on the University Promote good sportsmanship on and off the field Keep abreast on technical knowledge of the game Provide to Club Officers copy of any related certifications or outline regarding experience & skills Read and sign coach/instructor agreement/risk acknowledgement and background check forms Have personal medical insurance coverage (must provide proof/ copy of insurance card) Provide to Club Officers a copy of First Aid/CPR Certification Card, if current Establish a plan and course of action in regards to safety and minimizing risks If Safety Officer is not present at practice, game or competition: Ensure First Aid Kit and Injury Reports are available and completed when needed; follow the Club Sports First Aide Guidelines per Hand Book. Check practice areas for hazardous conditions and that equipment is good working condition Be familiar with and abide by the Club Sports Manual and all applicable University rules and guidelines Coaches/Instructors shall not: Sign on the club s university account for payment of any items Sign for vehicle reservations made on behalf of the club or made by the club Accept anything of value or make agreements in the name of the University or obligate the University in any manner
AUTHORIZATION FOR RELEASE OF INFORMATION Stetson University, Inc. ( Stetson or the University ) is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, religion, national origin, handicap, or marital status. We assure you that your opportunity for employment, volunteer services or contract services with the University depends solely upon your qualifications. You are a candidate for employment, contracted, or voluntary services at Stetson University. As a standard procedure for all individuals applying for employment, contract or voluntary work that involves direct contact with students, the University conducts appropriate background screening, including a review of a candidate s driving record (if driving as part of your duties or services is required). As a candidate for such employment, contracted or voluntary work, we request that you complete and sign this Authorization For Release of Information Form. The form must be fully completed for the University to further consider you for employment and/or contracted or voluntary services. This information is considered confidential and will be treated as such. Applicant/Candidate Name Social Security No. Date of Birth Driver s License No. State and County of Issue Current Home Address: How long at this address: Previous Address (if at current address less than 3 years): Position(s) Applied For Only U.S. Citizens or aliens who have a legal right to work in the U.S. are eligible for employment. Can you, upon employment, submit documentation verifying your legal right to work in the U.S. and your identity? Yes No In order to permit a check of your work, background and educational records, should we be aware of any changes of name or assumed name that you have previously used? Yes No. If Yes, identify names and relevant dates. Have you ever been convicted or found guilty of violating any federal, state or municipal law, other than a minor traffic violation? In answering this question, you are to consider all matters, regardless of whether adjudication was withheld or whether a nolo contendere plea was entered. Yes No. If Yes, give dates and explain. (Attach separate paper if necessary). Convictions will not necessarily disqualify you from employment, or volunteer/contracted services. *****************************************Candidate/Applicant s Statement*********************************** I certify that the information presented in my employment application with Stetson, and the statements attested to on this form, are true and complete to the best of my knowledge. I hereby authorize a background search to be done, to include my driving record if applicable; and authorize the investigation of all matters pertaining to any application for employment with Stetson that I have submitted, and thereby give Stetson permission to contact schools, previous employers, references, and others, and hereby release Stetson from any liability as a result of such contact. I understand that misrepresentations, omissions of facts or incomplete information in my application for employment or this form may remove me from further consideration for employment and contracted or volunteer services. In addition, if employed, any misrepresentations or omissions of facts called for in applying for employment will be cause for dismissal at any time without any previous notice. Signature Date