Volunteer Waiver Form – Hilma's Heart

TOWSON UNIVERSITY CAMPUS RECREATION GUEST AGREEMENT, WAIVER, HOLD HARMLESS AND COVENANT NOT TO SUE

Notice: This Agreement is a contract with legal consequences. Read it carefully before signing.

All volunteers complete Sections A and B:

A. WAIVER

B. MEDICAL AUTHORIZATION

A. Waiver

Name *

First

Last

Email *

Confirm Email *

Phone *

Event Name (please select the event you will be volunteering at: *

Towson University (MWS) - Field Day

Event Date (please select the date you will be volunteering) *

Saturday, April 16, 2022

Volunteer Shift *

11:30am - 5:00pm
1:00pm - 3:00pm

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 *

Volunteer 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 *

Volunteer 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):

I have carefully read this form and fully understand its contents. All information I have provided is true. I am aware that this is a release of liability, a waiver of claims, an agreement not to sue, an indemnity, and a contract between myself, Towson University, and Hilma’s Heart Community Organization and for the benefit of others described herein, I sign it of my own free will.

I understand.

Your E-Signature *

Volunteer Electronic Signature (Please type your first and last name)