TEAM SPORT ENTRY FORM

 

SPORT:   TEAM NAME:

MEN WOMEN COED

A LEAGUE   B LEAGUE

$5.00 individual entry fee due prior to play
Each individual MUST sign the waiver form prior to play.

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.

ALL PARTICIPANTS MUST COME INTO THE
STUDENT RECREATION CENTER TO SIGN THIS FORM.

 

 

PRINT NAME

SIGNATURE

EMAIL ADDRESS

TELEPHONE

1.

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2.

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3.

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4.

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5.

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6.

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7.

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8.

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9.

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10.

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

 

Ruth Olsen
Director of Intramurals

907-474-6814

ruth.olsen@uaf.edu

Copyright © 1998 by the Student Recreation Center
at theUniversity of Alaska Fairbanks
Last updated September 2007