SPORT: TEAM NAME:

MEN: WOMEN COED A LEAGUE B LEAGUE

WAIVER AND CONSENT FOR EMERGENCY TREATMENT:

I am aware that participating in this intramural activity involves several inherent risks of bodily injury. In consideration to the right to participate in this activity, I waive and release any and all rights and claims for damage I may have against the University of Alaska, its Board of Regents, officers, employees and agents, for any and all injuries suffered while participating in this activity unless such injury is caused by the gross negligence of the University of Alaska. I give consent to emergency treatment, including hospitalization as may be needed. I hereby agree to submit any disputes that may arise between myself and the University of Alaska, its agents, servants, and or employees, in the connection with my intramural activities at the University of Alaska, to binding arbitration in accordance with the rules of the American Arbitration Association. I am in good health and able to undertake in an intramural program.

EVERY PERSON INCLUDING THE CAPTAIN NEEDS TO
COME INTO THE STUDENT RECREATION CENTER TO SIGN THIS FORM.

ADDITIONS

	PRINT NAME	SIGNATURE	EMAIL ADDRESS	TELEPHONE
1.		Please come into the SRC to sign this form
2.		Please come into the SRC to sign this form
3.		Please come into the SRC to sign this form
4.		Please come into the SRC to sign this form
5.		Please come into the SRC to sign this form

DELETIONS

	PRINT NAME	SIGNATURE	EMAIL ADDRESS	TELEPHONE
1.		Please come into the SRC to sign this form
2.		Please come into the SRC to sign this form
3.		Please come into the SRC to sign this form
4.		Please come into the SRC to sign this form
5.		Please come into the SRC to sign this form

Date Received: _______ Time Received : _______ Received by: _______

Ruth Olsen
Director of Intramurals
University of Alaska Fairbanks

(907) 474-6814
ruth.olsen@uaf.edu

TEAM SPORT ADD/DELETION FORM