Field Day Participant Waiver – Towson University Guest Agreement

All participants complete Sections A and B:

A. WAIVER

B. MEDICAL AUTHORIZATION

Also complete Section(s) C and/or D, if applicable:

C. TRANSPORTATION

D. MINOR

A. Waiver

Particpant Name *

First

Last

Email *

Confirm Email *

Phone *

Event Name (please select the event you will be participating in):

Towson University (MWS) Field Day

Event Date/Time: (please select the event date/time): *

Saturday, April 16, 2022 I 12:00PM - 5:00PM

In consideration of my use of the Campus Recreation facilities as a guest, I hereby freely agree to make the following contractual representations and agreements: I fully realize the dangers of using the facilities at Campus Recreation and voluntarily assume all risks associated. I understand the risks include, by way of example, and not limitation, the following: Accidents may happen while traveling and walking to Campus Recreation facilities. Injuries can occur due to falls, equipment failure, other participants, over exertion, and adverse weather conditions. Injuries could result in concussion, broken bones, torn muscles or tendons, welts or scrapes, psychological harm, hospitalization or death. I agree that it is my sole responsibility to be familiar with the physical and/or mental demands associated with the above named events. With these demands in mind, I have no physical or mental condition, which to my knowledge, would endanger myself or others if I participate in this event, or would interfere with my ability to participate in the event. I also agree to abide by any established rules or regulations while engaged in this activity, and with the directions and precautions given by leaders and/or instructors. I understand that Towson University and Hilma’s Heart Community Organization has no duty to provide any extraordinary duties or safety measures in relation to this activity and that I must use reason and judgment in my undertakings hereunder. I consent to Towson University providing emergency health assistance if it is determined necessary in its discretion, and consent to Towson University contacting my emergency contact for notification. I understand and expressly assume all the risks and dangers of the activities contemplated by this Agreement, and I hereby release, waive, discharge, and covenant not to sue Towson University, the University System of Maryland, the State of Maryland, Hilma’s Heart Community Organization, and their officers, agents, servants, and employees (collectively, the “Releasees”) from all liability, claims, demands, actions, or causes of action whatsoever arising out of any damages, loss, or injury to me or to my property while participating in any of the activities contemplated by this Agreement, whether such damage, loss, or injury results from the negligence of the Releasees or from any other cause. I also hereby release, waive, discharge and covenant not to sue the Releasees from any claims whatsoever on account of any first aid, treatment, or service rendered to me during my participation in the above activity. I hereby agree to indemnify and hold harmless the Releasees from any loss, liability, damage, or costs, including court costs and attorneys’ fees, that they may incur due to my participation in said activities, whether caused by the negligence of Releasees or otherwise. I agree, for myself and my successors, that the above representations and agreements are contractually binding, and are not mere recitals. I agree that my failure or refusal to sign such agreements or releases shall in no way affect the validity of this Agreement, nor revoke or cancel any of the terms of this Agreement. I or any of my successors shall be liable for the expenses(including legal fees) incurred by the party or parties in defending against such claim or suit. This Agreement shall not be modified orally. *

I understand.

Your E-Signature *

Participant/Guardian Electronic Signature (please type your first and last name).

B. Medical Authorization

In the event of any illness or injury while participating in the activity listed in Section A, I hereby consent to whatever x-ray, examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care from a licensed physician, surgeon, and/or dentist as deemed necessary for my safety and welfare. It is understood that the resulting expenses will be my responsibility. *

I understand.

Your E-Signature *

Participant/Guardian Electronic Signature (please type your first and last name).

Participant’s Medical Insurance Carrier: *

Medical Condition

Check here if you have a special medical condition and attach a description or describe that condition to this form or provide a brief description in the field below:

Medical Description (Brief Description Details)

Medical Condition Description Details

Click or drag a file to this area to upload.

Emergency Contact: In the event of illness, accident, or other emergencies, please notify:

Name *

First

Last

Phone *

Relationship to Volunteer: *

Other person(s) you would like us to contact (optional):

Phone Number(s):

C. Transportation

I do hereby fully release and forever discharge Towson University, the University System of Maryland, the State of Maryland, Hilma’s Heart Community Organization, and their officers, agents, servants, and employees (collectively, the “Releasees”) from any and all claims for injuries, damages or loss that I may have or which may accrue to me and arising out of, connected with, or in any way associated with said transportation services. By checking this box below on this document acknowledges that I have carefully read these provisions and I fully understand and willingly agree to abide by these terms. *

I understand.
N/A. I will be providing my own transportation to and from the event.

Your Signature *

Volunteer/Guardian Electronic Signature

D. Minor (For students/volunteers under 18 years of age, the parent or guardian completes this section in addition to Sections A and B; and C, where applicable.)

Minor Participant's Name: *

First

Last

Gender *

Female
Male

Age: *

Son/Daughter's: Date of Birth: *

Consent *

The minor listed above has my permission to participate in the event listed in Section A.

Parent/Guardian (on behalf of Minor Participant) *

First

Last

Your E-Signature *

Parent/Guardian Electronic Signature

Medical Conditions:

Check here if there are no medical conditions that the staff should be aware of and if your son/daughter is NOT required to use any medications during this event.

Medications:

Check here if your son/daughter must take medication(s) during the excursion/field trip and list them on this form or hereto attached. All medications, except those which must be kept on the minor’s person for emergency use, must be kept and distributed by Hilma's Heart staff.

Name of medication and reason for use:

Parent/Guardian (on behalf of Minor Volunteer) *

First

Last

Parent/Guardian Phone: *

I have read, understand and agree to all provisions of Section A: Waiver; Section B: Medical Authorization; and Section C, as appropriate; as related to my son/daughter’s participation in this event. *

I understand.

Your E-Signature *

Participant/Guardian Electronic Signature (please type your first and last name).