Participant Waiver Packet

Personal Information

Only complete this form if you have been accepted by the club.

Sport Club [Required] Please Select which club(s) that you are joining. Only complete this form if you have been accepted by the club. * (Maximum authorized answers: 3)

Fitness

Table Tennis

Tennis

Men's Soccer

MMA

Men's Volleyball

Women's Soccer

Gender that you identify as: *

Male

Female

Information Release for Sport Club Team Eligibility Certification (FERPA Agreement)

Student ID Number *

Full name *

Campus *

LU-Beaumont

LIT

The release of such information shall be restricted to any and all official representatives of the Sport Club Program and primarily for the purpose of determining my eligibility for athletic participation. By signing this form I understand that this entire form also becomes a part of my educational record and it along with any part of my academic record may be disclosed to the indicated Sport Club program in the event that I am involved in any eligibility infraction matter based on the Sport Club programs, rules and regulations. *

I Agree

Birth Date (for Verification Purposes) Example: 8/10/2012 *

Phone Number (For Verification Purposes) Example: 409-880-0000 *

Email (For Communication Purposes) *

Informed Consent Form

Please Read Carefully before Signing [Required] I do hereby affirm and acknowledge that I have been fully informed of the inherent hazards and risks associated with participating in athletic activities. I fully understand that these risks can lead to personal injury, illness, paralysis, permanent disability, and death or damage or destruction to my property. Additionally, I understand that there are also risks associated with travel, including, but not limited to the possible injury or loss of life or property as a result of an accident, as well as travel to and from activity sights (hereinafter collectively referred to as Sport Club activities or Sport Club participation). Other risks associated with Sport Club activities include but are not limited to: stoppage of breathing, spine and neck injuries (either of which could result in paralysis), concussion, heart failure, broken legs, feet, ankles, toes or other bones, heat stroke, heat cramp, heat exhaustion, stroke, convulsion, unconsciousness, abrasions to limbs such as arms, legs and head, fainting, sudden illness, cramps, and loss of wind. With respect to water sports, there is also the risk of drowning.
I also understand that there are risks to my physical and mental condition that may be caused by the physical exertion associated with Sport Club participation. Despite the potential hazards and dangers associated with the activity of Sport Club participation, I voluntarily agree to participate in the activity and hereby accept and assume all such risks, known and unknown, and assume all responsibility for the losses, costs and/or damages following such injury, disability, paralysis or death or damage or destruction to my property, even IF CAUSED, IN WHOLE OR PART, BY THE NEGLIGENCE OF LAMAR UNIVERSITY with the exception of willful or gross negligence.
I understand the nature of Sport Club participation and my experience and capabilities, and believe myself fully qualified and able to participate in the activity. I understand that I may inspect the premises, facilities and equipment to be used or with which I may come in contact. If I believe anything is unsafe, I will immediately refuse to participate further in the activity. I understand there is no penalty or forfeiture of any sort if I withdraw.
I have read the statement above and below and acknowledge the information. *

I Agree

Release and Indemnification Agreement

Please Read Carefully before Signing [Required] I, the above named student, am eighteen years of age or older (or if a minor, with the written permission of my parents or guardians below), and have voluntarily applied to participate in the above Activity or Trip. I acknowledge that the nature of the Activity or Trip may expose me to hazards or risks that may result in my illness, personal injury or death and I understand and appreciate the nature of such hazards and risks.
In consideration of my participation in the Activity or Trip, I hereby accept all risk to my health and of my injury or death that may result from such participation and I hereby release LAMAR UNIVERSITY, and the TEXAS STATE UNIVERSITY SYSTEM, their Regents, officers, directors, employees, representatives, agents and volunteers (hereinafter the Released Parties) from any liability to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my participation in the Activity or Trip, WHETHER CAUSED BY NEGLIGENCE OF THE RELEASED PARTIES, or otherwise. I further agree to indemnify and hold harmless the Released Parties from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in the described Activity or Trip. *

I Agree

Emergency Contact Information

Name of Nearest Relative *

Emergency phone of nearest relative. *

Upload CPR/First Aid Certification

Upload Cards Here If you have electronic copies of your CPR/First Aid Certification Card, please upload them here.

Upload file

Upload Cards Here If you have electronic copies of your CPR/First Aid Certification Card, please upload them here.

Upload file

Important Reminder!

YOU ARE NOT YET ELIGiBLE TO COMPETE! [Required] You do not need to do anything else. We will have your enrollment status and GPA checked to ensure that you are eligible to participate on a Sport Club. We will approve or deny your submission, after we check your eligibility status *

I Agree

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