Guest Waiver – Hilma's Heart

All guests must complete Sections A and B:

A. WAIVER

B. MEDICAL AUTHORIZATION

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

C. TRANSPORTATION

A. Waiver

Guest Name *

First

Last

Gender: *

Female
Male

Do you agree to bring identification with you?: *

Email *

Confirm Email *

Phone *

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

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 *

Guest Electronic Signature (please type your first and last name).

B. Medical Authorization

In the event of any illness or injury while attending 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.

Guest's E-Signature *

Guest Electronic Signature (please type your first and last name).

Guest’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 Guest: *

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 *

Guest Electronic Signature (please type your first and last name).

D. Participant Information (For parents, guardians or caregivers attending the event with their participant, please provide information about the student you are attending this event with).

Participant's Name: *

First

Last

Please provide the name of the student you are attending this event with.

Relationship to Participant: *

Participant's School *

Participant's Grade: *

6th Grade
7th Grade
8th Grade

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 attendance at this event. *

I understand.

Guest's E-Signature *

Guest Electronic Signature (please type your first and last name).