Wellness/Recreation/Intramural Sports Program 

Participation Waiver Form

This Form must be read and completed prior to participation in EOU Wellness/Recreation/Intramural Sports Program activities.


The Oregon Tort Claims Act (ORS 30.280 to 30.300) permits Eastern Oregon University to accept responsibility only for the acts of its officers, employees, and/or agents. Eastern Oregon University is prohibited from
accepting any liability for the acts, omissions and conduct of  persons participating in activities. The participant shall indemnify, defend and hold harmless the State, Eastern Oregon University, its officers, employees and agents from all claims, suits, or actions of any nature arising out of participation in these activities, other than negligent acts of Eastern Oregon University, its officers, employees, and/or agents.

I acknowledge that I am participating in this activity at my own risk. I understand that, due to the inherent nature of the activity, there is a risk of injury in participating in these activities. By signing below I acknowledge that I have read the risks above and understand the assumption of general risk and agree to the conditions listed above.

Participant’s Signature___________________________________ Date __________

Known medical conditions or restrictions __________________________________________________________________________

(e.g.: diabetes, heart disease, arthritis, recent back surgery, epilepsy, prescription drug interference; pacemaker; etc)

 

________________________________________ Signature       _________________ Date

_________________________________________ Print Name    _________________ Phone

Team(s) Playing For: _______________________________________________________________

EOU strongly recommends that all participants carry insurance either through a family plan or individual plan.

Insurance Carrier ___________________________________

In Case of Emergency ________________________________ Relationship ______________

Phone _____________________