WVWC LACROSSE CLUB TEAM CLINIC PARTICIPANT INFORMED CONSENT AGREEMENT

 
I________________________________________ hereby acknowledge that participation in Lacrosse activities organized by WVWC Women’s Lacrosse Club Team may involve risk of injury, minor or serious, including permanent disability. These types of injury may result from my own actions, the actions or inactions of others, or a combination of both.

IT IS THE RESPONSIBILITY OF EACH INDIVIDUAL to know his or her own general state of health and well-being, and therefore to be able to certify knowledgeably that he or she is physically fit to participate in the Lacrosse clinic.

IT IS ALSO THE RESPONSIBILITY OF EACH INDIVIDUAL to have health insurance coverage sufficient to provide for medical or dental services and/or equipment required to treat any injury, minor or catastrophic, sustained or incurred as a result of participating in the Lacrosse Clinic program, and to certify that such insurance coverage is held.  

Therefore, AS A PRECONDITION TO BEING GRANTED PERMISSION TO PARTICIPATE IN THE SPONSORED EVENT BY WVWC LACROSSE CLUB TEAM, EACH PARTICIPANT shall read the agreement set forth below in order to make an educated choice to participate or not participate.  Your signature will signify your recognition of the possible health risks involved and your informed consent to them.

I understand that the rules and regulations are designed for the safety and protection of participants and I hereby undertake to abide by all rules and regulations conveyed by each presenter. I also understand that certain activities require a minimum level of fitness for safe participation.  (initials) X________

I certify that to the best of my knowledge, I am physically fit and able to participate in lacrosse related activities, that I am in good health, and that I am unaware of any medical condition, which might make my participation inadvisable. (initials) X________

I acknowledge my responsibility to acquire health insurance coverage sufficient to provide for all medical or dental services and/or equipment to treat any injury, minor or catastrophic, related to my participation in the WVWC LACROSSE CLINIC, AND HEREBY CERTIFY that on the date noted below, I have such insurance coverage in effect.  (initials) X________

In consideration of WVWC LACROSSE CLUB TEAM permitting me to participate in its CLINIC event on February 9, 2008, I knowingly and intentionally give up any legal right that I, my heirs, or legal representatives have or may have against West Virginia Wesleyan College, its trustees, officers, agents, employees, or insurers, from any action, claim, or demand that I, my heirs, or my legal representatives have or may have for any and all personal injuries I may suffer or sustain, regardless of cause or fault, on- or off-campus, as a result of my voluntary participation in WVWC LACROSSE CLUB TEAM CLINIC and/or in other activities related thereto. 

(initials) X________

I certify that I am legally competent and capable of executing this Agreement with the full consent of my parents/legal guardian and both parities have read the foregoing and have made a conscious decision to sign it of their own free will.

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DATE                                                  PARTICIPANTS SIGNATURE

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DATE                                                  PARENTS/LEGAL GUARDIAN SIGNATURE