University of Cincinnati
Club Sports Board
Student Activities and Leadership Development
455 Steger Student Life Center / PO Box 210136
Cincinnati, OH 45221-0136

Release and Indemnity Agreement for Participation in a Club Sport



Personal
First Name:
Last Name:
Phone:
Bearcat Online (BOL): *e.g. username usually to left of @ in UC email address
UCID: *e.g. M01234567
Email:


Insurance
Insurance Carrier:
Policy Number:
Allergies:


Emergency Contact
Name:
Relation:
Phone:
Notes:
*List any extra contact, medical or pertinent information


Release

As part of the consideration for participating in the University of Cincinnati Club Sports Program and for using the associated practice and playing facilities and equipment, and in consideration of the voluntary nature of such participation and use, I hereby release, hold harmless, and forever discharge the State of Ohio, me, and the University of Cincinnati, its employees and agents, from any and all liability, claims, demands, actions, and causes including death, that may be sustained by me or to any property belonging to me, whether caused by the negligence or carelessness of the University, its employees and agents, or otherwise and which occurred while participating in such activity. Such participation includes practice, club functions, competition, and travel to and from all Club Sports activities.

I am fully aware of the risks and hazards associated with participation and use of the facilities and equipment. I hereby elect voluntarily to participate in said activities and fully acknowledge that the full responsibility for any risk or loss, property damage, or any personal injury including death, that may be sustained by me or loss or damage to property owned by me as a result of engaged activities, whether caused by the negligence or carelessness of the University, its employees or agents, or otherwise. I further acknowledge that I have acquired on my own adequate insurance for such loss, damage, and injury. I further agree to indemnify and hold harmless the University, its employees and agents, from any loss, damage or cost, including court costs and attorney's fees that they may incur due to my participation in the club sport activities, whether such loss, damage, or injury was caused by the negligence or carelessness of the University, its employees or agents, or otherwise.

This release and hold harmless agreement is binding on myself, my heirs, assigns, and personal representatives. I acknowledge that I am 18 years old or more.

Signature





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