Student Athlete Acknowledgment and Assumption of Risk

I,  , hereby acknowledge and declare the following:

I understand that participation in sport requires a personal acceptance of risk of injury. Athletes generally expect that those who are responsible for the conduct of sport take reasonable precautions to minimize such risk and that their peer's participation in the sport will not intentionally inflict wrongful injury upon them.

I understand that participation in Athletics at Brandeis University may result in injury/illness, physical or mental impairments, or even death. I understand that Brandeis University cannot be held responsible for any injuries or conditions that may be caused by the actions of other athletes or teams. I also understand that injuries may be caused by my own failure to follow safety procedures or techniques, which are made known to me by the coaching staff, the athletic training staff and/or are otherwise know to me from another source including, but not limited to medical personnel of the University.

I have read the above shared responsibility statement. I understand that there are certain inherent risks involved in participation in intercollegiate athletics. I acknowledge the fact that these risks exist and I am willing to assume responsibility for any and all such risks while participating in Intercollegiate Athletics at Brandeis University. I also agree to the following:

A. I voluntarily assume all risks associated with my participation in Athletics at Brandeis University.

B. I accept that Brandeis University and its personnel are not to be held responsible for any pre- existing medical condition(s) that I may have.

C. I understand that I must refrain from practice while injured or ill, whether or not receiving medical care. When under medical care I may not return to participation until I have been given permission, based on independent exercise or professional judgment, by the attending Team Physician(s) or his/her designate after review of my condition and fitness for the rigors of my sport. This may occur during or at the conclusion of medical treatment(s).

D. I understand and agree that if I experience an injury/illness or change in my health status it is my responsibility to inform my Head Coach and a Certified Athletic Trainer and adhere to the established injury management guidelines, which includes total rehabilitation and reassessments before I am released to return to full participation.

E. I understand that I must wear the proper equipment as dictated by the rules of the sport. I may also have to wear padding or braces as indicated by the Athletic Training Staff or Medical Personnel. Failure to do so may put me at risk for further injury.

BY CHECKING THE FOLLOWING BOX, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND VOLUNTARILY AGREED TO THE ABOVE STATEMENTS: 

NAME: 

SPORT:

E-MAIL ADDRESS: 

LAST FOUR NUMBERS OF SAGE STUDENT ID #:

DATE (MM/DD/YYYY):