6231 6231 Walkon Tryout Waiver 2012 PDF

Sport____________
Glendale Community College

Walk-On Tryout/Evaluation Form
RELEASE FOR PERSONAL INJURY AND DAMAGE
All physical activity has risks that may range from a fall, to muscle and ligament damage, to circulatory or
heart disorders. Consequently you must make sure that your health is adequate to participate in the
strenuous, vigorous physical activity involved in athletic tryouts. It is your responsibility to check with the
physician of your choice about your health status and if there is any question regarding your fitness for
participation. If you, at any time during your participation, experience any distress or have any questions
regarding your participation, notify your coach or athletic trainer. Glendale Community College provides
no student accident insurance or athletic accident insurance for tryouts. You must provide your own
coverage.
WHEREAS the undersigned voluntarily desires to participate in a Glendale Community College athletic
walk-on tryout/evaluation; and
WHEREAS the undersigned is duly aware of the risks and hazards that may arise through participation in
said activity and that participation in said activity may result in loss of life, limb, property, or all three, of
the undersigned.
THEREFORE, it is agreed as follows:
THAT in consideration of being allowed to participate in said activity, the undersigned hereby voluntarily
assumes all risks and accident or damage to his/her person or property and all risks of liability or
demands of any kind sustained, whether caused by the negligence of Glendale Community College agents
or employees, or otherwise; and
THE undersigned further voluntarily agrees that the above release shall be binding upon their heirs,
administrators, executors, and assigns, of the undersigned; and
THE undersigned hereby affirms having accident insurance coverage and having adequate health status to
participate in strenuous physical activity. The undersigned further acknowledges that the undersigned has
the right to refuse to attempt, or to withdraw from the physical activity for any reason. The undersigned
accepts the responsibility to report any injury, distress, preexisting condition that may impair
performance, or other problems to the coach or the athletic trainer.
THE undersigned, by signing this release, hereby certifies that the undersigned has read and fully
understands and agrees with the conditions herein provided.
Name: _______________________________________ Date of Birth: __________________

(Print)
Name: _______________________________________ Date: ________________________

(Signature)
Parent’s Signature (if under 18 years of age): _________________________________________

Sport____________
Assumption of Risk and Release of Liability

I ________________________, freely choose to participate in the athletic program (henceforth
referred to as the “Program”) at Glendale Community College. In consideration of my
participation in this program, I agree as follows:
RISKS INVOLVED IN PROGRAM: Participation in all sports requires an acceptance of risk of injury, such as
pre-season physical examinations, proper facilities maintenance, and instruction of correct sports technique; we
attempt to provide a safe, competitive environment for all student athletes. In addition we have team physicians,
(general practitioner and orthopedic specialist) and certified athletic trainers to assist you with injury prevention and
treatment.
In spite of these efforts, injuries do occur. Athletic competition, by its very nature results in numerous uncontrollable
situation where injuries cannot be avoided. As an athletic participant, there is always the possibility that you may
sustain an injury. The injury may range from a minor one to one of great severity and which could result in
deformity, paralysis, or even death.
HEALTH AND SAFETY: I have been advised to consult with a medical doctor with regard to my personal
medical needs. I state that there are no health-related reasons or problems that preclude or restrict my participation in
this Program. I have obtained the required immunizations, if any.
I recognize that Glendale Community College is not obligated to attend to any of my medical or medication needs,
and I assume all risk and responsibility therefore. In case of a medical emergency occurring during my participation
in this
Program, I authorize in advance the representative of Glendale Community College to secure whatever treatment is
necessary, including the administration of an anesthetic and surgery. Glendale Community College may (but is not
obligated to) take any actions it considers to be warranted under the circumstances regarding my health and safety.
Such actions do not create a special relationship between the Maricopa County Community College District
(MCCCD) and me. I release the MCCCD, its officers, officials, employees, volunteers, students, agents and assigns
from all liability for any bodily injury or damage I sustain as a result of any medical care that I receive resulting
from my participation in
Program, as well as any medical treatment decision or recommendation made by an employee or agent of the
MCCCD. I agree to pay all expenses relating thereto and release Glendale Community College from any liability for
any actions.
ASSUMPTION OF RISK AND RELEASE OF LIABILITY: Knowing the risks described above, and in
voluntary consideration of being permitted to participate in the Program, I agree to release, indemnify, and defend
Glendale Community College and their officials, officers, employees, agents, volunteers, sponsors, and students
from and against any claim which I, the participant, my parents or legal guardian or any other person may have for
any loses, damages or injuries arising out of or in connection with my participation in this Program.
SIGNATURE: I indicate that by my signature below that I have read the terms and conditions of participation and
agree to abide by them. I have carefully read this Release Form and acknowledge that I understand it. No
representation, statements, or inducements, oral or written, apart from the foregoing written statement, have been
made. This Release Form shall be governed by the laws of the State of Arizona which shall be the forum for any
lawsuits filed under or incident to this Release Form of to the Program. If any portion of this Release Form is held
invalid, the rest of the document shall continue in full force and effect.
___________________________________ ____________________
Signature of Student (or Parent/Guardian if under 18) Date
__________________________________________
Print or Type Full Name

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Sport____________

Glendale Community College

THEREFORE, it is agreed as follows:

Name: _____________________ Date of Birth:

Name: _______________ Date:

Parent’s Signature (if under 18 years of age): _________________________________________

Assumption of Risk and Release of Liability

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