LIABILITY WAIVER OPTION I

CONSENT FOR EVENT ACTIVITIES AND FOR TREATMENT

PARTICIPANT

First Name

Last Name

Birth Date

EVENT INFORMATION

Event Name

MEDICAL INFORMATION

Leave blank where not applicable.

Known Allergies

Current Medications

Physical Restrictions

Previous Injuries

If you have had no previous injuries, enter 'none'.

Other info that emergency assistance providers should know:

PARENT/GUARDIAN INFORMATION

First Name

Last Name

Address

City

State

Zip

Mobile Phone

XXX-XXX-XXXX

Home Phone

XXX-XXX-XXXX

Work Phone

XXX-XXX-XXXX

MEDICAL PROFESSIONAL

Full Name

Office Phone

XXX-XXX-XXXX

Mobile Phone

XXX-XXX-XXXX

Pager

AUTHORIZED ADULTS

Authorized for medical notification and pick-up.

CONTACT ONE

Full Name

Mobile Phone

XXX-XXX-XXXX

Home Phone

XXX-XXX-XXXX

Work Phone

XXX-XXX-XXXX

CONTACT TWO

Full Name

Mobile Phone

XXX-XXX-XXXX

Home Phone

XXX-XXX-XXXX

Work Phone

XXX-XXX-XXXX

Behavioral Management

I understand that:

a) behavior which disrupts the program or poses a threat to the safety of self or others will not be tolerated;
b) if Participant is unable to self-regulate their behavior then, after the event sponsor (or its agent) has made a good faith effort to resolve the issue (and, if Participant is a minor, consult with a parent or legal guardian), Participant may be removed from the remainder of the event; and
c) in such case there will be no refund of fees.

Authorization for Medical Care

If an injury or illness requires, in the opinion of the person in charge, urgent medical or dental examination or treatment, I authorize and direct that person (or their agent) to:
a) arrange transportation by car or ambulance to the closest hospital;
b) call the Medical Professional/s named above; and
c) attempt to reach one or more of the other listed contacts.
If a named Medical Professional is unavailable, I authorize any emergency treatment deemed necessary by a medical professional licensed for the required service.

Acceptance of Circumstances & Assumption of Risk

I understand that Westmont College assumes no financial responsibility or legal liability for medical care or ambulance transportation. I also verify that the Participant is in sufficient health to be able to participate in the event identified above. I recognize that all physical activity has some risk of injury.

Image Release

I authorize the use, in future program publications, of biographical, image, video or audio content recorded for or during event activities and include this Participant.

Electronic Signatures

A signed copy of this waiver submitted via this form shall be deemed to have the same legal effect as delivery of an original executed copy of this waiver for all purposes.

SIGNATURE

Signature of Parent/Legal Guardian or Participant if over 18

Date

ACTIVITY PARTICIPANT'S RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK,
& INDEMNITY AGREEMENT

PARTICIPANT

First Name

Last Name

Birth Date

PROSPECT CAMP

WESTMONT'S MEN'S BASEBALL PROSPECT CAMP

Event Name

In consideration of being permitted to participate in the Baseball Prospect Camp (hereinafter “ACTIVITY”) being held on November 10, 2024 by Westmont College, I, on behalf of myself, my executors, heirs, administrators and assigns, hereby voluntarily agree to release, waive, discharge, hold harmless, and agree not to sue Westmont College, its trustees, officers, employees, agents, and volunteers, for any and all claims, damages, costs, attorney's fees, or causes of action which I have or may have in the future that arise as a result of damages, injuries, including death, relating or arising out of or incident to any negligent act or omission by Westmont College, its trustees, officers, employees, agents, and volunteers, or by other participants in the Baseball Prospect Camp. I knowingly and voluntarily give up valuable legal rights, including the right to sue.

Additionally, I agree to indemnify and defend Westmont College, its trustees, officers, employees, agents, and volunteers for any and all claims, damages, costs, attorney's fees, or causes of action that arise as a result of damages, injuries, including death, relating or arising out of or incident to any act or omission by me.

I understand and agree that there are risks of harm associated with participating in ACTIVITY, which may give rise to death or bodily injury, and/or property damage. These risks include, but are not limited to, exposure to COVID-19, orthopedic injury, head injury, loss of consciousness, ambulance transportation and other general medical conditions. I further understand and agree that there may be risks and dangers not known or reasonably foreseeable at this time. I understand and agree that included within the scope of this waiver and release is any cause of action, arising from the performance of or the failure to perform maintenance, inspection, supervision or control of ACTIVITY or the failure to warn of existing dangerous conditions not known to or reasonably discovered by Westmont College, including all acts of negligence of Westmont College. I, the negligence of others, or by the negligence of Westmont College, its trustees, officers, employees, agents, and volunteers, may cause these risks and dangers. I knowingly and voluntarily assume full responsibility for these risks arising out of or related to my participation in ACTIVITY.

I HAVE CAREFULLY READ, AND I UNDERSTAND, ACKNOWLEDGE AND AGREE TO THIS RELEASE, WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT. I UNDERSTAND THAT I AM GIVING UP VALUABLE LEGAL RIGHTS BY SIGNING THIS AGREEMENT, AND THAT THIS AGREEMENT REPRESENTS A CONTRACT BETWEEN WESTMONT COLLEGE AND MYSELF. I HAVE AGREED TO SIGN THIS AGREEMENT OF MY OWN FREE WILL.

SIGNATURE

Signature of Parent/Legal Guardian or Participant if over 18

Date

*Electronic signatures, facsimiles, and any other electronic transmission of this signed document shall have the same legal validity and enforceability as a manually executed signature.

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