Media $0 Enter Total. Enter Discount. Multi Sport Discount ($100) Total After Discount

Similar documents
MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM

Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form

2016 5K Reindeer Run/Walk Team Registration

Lake Washington Rowing Club

St. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01)

WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree:

Promoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF.

Requirements for Volunteer Club Coaches

Please print and submit your study abroad application and deposit to the FVCC Business Office in Blake Hall.

South Suburban Youth Rugby Club

2019 United States Snowshoe Association Event Sanctioning Application

Please fill out both sides of this form!!!

Schedule: When: Saturday, December Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete

NSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m.

COLLEGE OF CHARLESTON LIABILITY RELEASE, EMERGENCY MEDICAL AUTHORIZATION AND AGREEMENT (Domestic Travel)

UREC Sport Clubs Program Staff

APPLICATION FOR PART TIME EMPLOYMENT

INSURANCE INFORMATION

Blue Knob Snow Sports Club, Inc Registration Form 2018/2019 Ski Season

St. Thomas of Villanova Scholars (STOVS) Summer Program July 5-22, 2017

Kids Creation Camp SCHOLARSHIPS ARE AVAILABLE! $205/Child $245/Child

STUDENT AND PARENT PARTICIPANT S AGREEMENT WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

Release of Liability PLEASE DO NOT CHANGE OR ALTER THE WORDING ON THIS WAIVER WITHOUT PRIOR APPROVAL FROM USROWING.

WHEN: Saturday, February 6, 2016 WHERE: Goergen Athletic Center All-Purpose Recreation Courts

AGREEMENT TO TERMS AND CONDITIONS OF CPCC EDUCATION ABROAD AND WORK-RELATED TRAVEL PROGRAMS

Cardiothoracic Surgical Skills and Education Center 2015 Stanford Summer Internship

Name: Phone: Name/Phone of Emergency Contact:

Telluride Ski and Golf Assumption of Risk, Release of Liability, and Indemnity Agreement 3. Media Release: 4. Medical Care: 5.

STUDY ABROAD APPLICATION AND DEPOSIT

2017 Haunted Halloween Race

Study Abroad Program - Code of Conduct and Guidelines

FORM 1 Trip Itinerary Complete one form for the entire group. Fill all blank spaces or mark N/A if not applicable.*

Travelearn Participant Form

MEMBERSHIP CATEGORY (circle one) For current dues please refer to the website Membership page

UCI SUMMER SESSION 2011 TRAVEL-STUDY PROGRAMS APPLICATION PACKET CHECKLIST

Clayton State University Division of Student Affairs. Student Travel Agreement Form

Florida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers)

Hobart and William Smith Colleges and Union College Partnership for Global Education

ManHood Camp LA 2017 Registration Paperwork Instructions

Auburn University Club Sports Assumption of Risks, Informed Consent, Waiver and Hold Harmless Agreement

UGA Livestock Judging Camp Athens, Georgia June 26-28, Participant Name: Parent/Guardian: Phone: Address: City: State: Zip: School:

Camp Medical Information & Release Form

TULANE UNIVERSITY ATHLETICS CAMPS Physical Examination Information. Date / / Name of Camp: Name of Participant: Age: Birth date: / /

Upper Natoma Rowing Club Junior Member Application (Please print clearly)

East Carolina University Division of Continuing Studies Summer Study Abroad Program Application

Travel Registration Packet

NON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS

2013 USACA MEMBERSHIP & INSURANCE

UNITED STATES AUTO CLUB

CUNY OFF-CAMPUS STUDENT TRAVEL APPROVAL FORM New York City College of Technology

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet

Can-Am X-Team Racer Support Program Application Form PLEASE PRINT CLEARLY. INCOMPLETE OR ILLEGIBLE FORMS WILL DELAY PROCESSING.

SCCA Rally/Solo Release and Waiver Guidelines

General Policy - Off-Campus Travel of Student Groups

Math + Leadership Camp Rancho Minerva Middle School July 11-22, Registration Form

FACULTY-LED STUDY ABROAD PROGRAM APPLICATION

Colorado Trek Paper Work Check List

TEXAS A&M INTERNATIONAL UNIVERSITY

Auburn University Montgomery

OHIO CAMPus REC Summer Camp

SKATEBOARD COMPETITION ENTRY FORM

ALL DRIVERS MUST COMPLETE INFORMATION BELOW

Raising Money for Autism

Duke Administered Study Away Participation Agreement

The purpose of this policy is to define standards associated with the use of volunteers.

Application for Admission to the Rust College Living Into Our Future Youth Theology Institute for Rising High School Juniors and Seniors

Study Abroad Costa Rica 2016

2015 LBSC Ski Club Week Trip Aspen, Colorado

UNITED STATES AUTO CLUB

Tentative Schedule UGA Livestock Judging Camp Athens, Ga :00 am- 12:00pm Registration Double Bridges. 12:00 Orientation Double Bridges

PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE:

MAKE WELLSTON BEAUTIFUL, INC

You must have health insurance to attend this trip!

The College of Engineering & Computer Science Webelos Engineering Pin Day Saturday, October 28, 2017

New Patient Intake Paperwork

Study Abroad Application Checklist Form Student Travel Committee Student Activities Association

Date of Birth Address City State Zip

Waiver of Liability, Assumption of Risk, and Indemnity Agreement

2016 OUCI Chinese Bridge Summer Camp Application

ESO GIRLS FASTPITCH SOFTBALL 2017 PLAYER REGISTRATION

COLLEGE OF CHARLESTON STUDENT CONSENT, MEDICAL AUTHORIZATION, AND RELEASE AGREEMENT (International Travel) Name of Program:

Nights of Lights Youth Opti Regatta. ENTRY FORM AND RELEASE OF LIABILITY AGREEMENT Saturday December 15, Skipper s Name: DOB: Age: Boat/Fleet:

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone:

CUNY INTERNATIONAL TRAVEL PARTICIPATION, WAIVER,

Participant Registration Form

Corynna s Wish. Application for Corynna s Wish. Here Are the Requests We Are Unable to Grant. Eligibility Requirements for Recipients

First Name: Middle Initial: Last Name: Gender: D.O.B: / / Age: Years of YMCA Camp Participation: Address: Apt/Unit #:

Math + Leadership Camp CSU San Marcos. Registration Form

TRAVEL REQUEST FORM 1 (TR1) REQUEST FOR APPROVAL OF LSC SPONSORED STUDENT TRAVEL

Tarrant County College South Campus Generation Hope Student Application

ARKANSAS STATE UNIVERSITY STUDY ABROAD PARTICIPANT AGREEMENT

University of Rochester Elite Lacrosse Clinic

Customer will pick up the card: Mail card to customer: Yes To home address: To UF Campus address:

LVC SPORTS CENTER ACTIVITIES CAMP JUNE 11 14, 2018

2018 Youth Academy Parent/ Guardian Agreement with NUS s Continuing Education

SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM

STUDY ABROAD WAIVER OF LIABILITY, INDEMINIFICATION, AND MEDICAL TREATMENT AUTHORIZATION AGREEMENT

EQUIPMENT LENDING AGREEMENT

Academic Studies Abroad FUA Florence University of the Arts APPLICATION FORM SPRING 2015

Transcription:

2018-2019 Mountain Sports Dues - Name: The online registration calculated your dues. You can also use the table below to calculate your Mountain Sports dues. Please note that your dues may not cover expenses such as individual licenses, lift tickets, food, required equipment, some entry fees, etc. Please refer to http://wscumountainsports.com/frequently-asked-questions/ for more information on what is and isn t covered by your team dues. Team Dues Enter Cost Mountain Bike - Combined (XC and Gravity) $700 Mountain Bike - Cross Country $600 Mountain Bike - Gravity $600 Trail Running $600 Freeride (Big Mountain) $700 Alpine Race $1500 Nordic Race $1500 Endurance Ski $400 Media $0 Enter Total Multi Sport Discount ($100) Enter Discount Total After Discount Pay by credit card: https://commerce.cashnet.com/westernmtnpay. Contact gchase@western.edu for multi-sport discount coupon. Or enclose a check payable to Western State Colorado University with the student name in the memo line for the full amount shown in the Total After Discount box and mail to: Director of Mountain Sports Mountaineer Field House 175 500 E. Ruby Avenue Gunnison, CO 81231

Western State Colorado University Mountain Sports Student-Athlete Code of Conduct I. Standards of Conduct 1. As a student athlete at Western State Colorado University, I promise to uphold the WSCU Student Affairs Code of Academic and Behavioral Codes of Conduct throughout my participation in Western Mountain Sports. 1a. Student athletes are not members of a team until they pay membership dues. This Code of Conduct is a promissory note for membership dues for an individual team or teams; failure to pay full dues by the end of a competitive season will result in disciplinary action. 2. Student-athletes at the Western State Colorado University are subject to the standards and conduct embodied in the following: State, federal, civil and criminal laws Western State Colorado University Student Conduct Code and other applicable student conduct policies, including the hazing policy Maintaining a cumulative GPA of 2.0 or higher after the students first semester Individual League Rules Violation of any of these standards of conduct may result in discipline, as further described in Part II The failure of a student-athlete to report to the Mountain Sports Staff, within 24 hours, any violation of the above standards of conduct may also result in discipline, as further described: II. Sanctions and Disciplinary Process Violation of Team Rules - The Mountain Sports Staff has the authority to impose sanctions for violations of team rules. Violation of Other Rules or Policies - For violations of rules and policies other than team rules (For example, violations of Club rules, the Student Conduct Code, etc.), the Mountain Sports Staff may impose sanctions. Obtaining a cumulative GPA below 2.0 - When a student athlete obtains a GPA below 2.0 they will be suspended from competition indefinably or until the student athletes raises their GPA above a 2.0 on their final grades. Violation of Criminal Law - When a student-athlete has engaged in conduct that is in violation of the criminal law, whether that conduct constitutes a misdemeanor, gross misdemeanor, felony, or any other class of criminal conduct, the Mountain Sports Staff must report that information to the Director of Mountain Sports and may impose sanctions with the approval of Director of Campus Recreation. Administrative Suspension When Student-Athlete Charged with Criminal Violation. Student-athletes who are arrested for or charged with violating the criminal law will be placed on immediate administrative suspension from involvement in team activity pending further investigation. If the alleged violation of law would constitute a misdemeanor violation, the Mountain Sports Staff has the authority to decide whether to

lift the administrative suspension. If the alleged violation of law would constitute a more serious violation, however, only the campus administers may lift the administrative suspension. In all cases in which a student-athlete is arrested for or charged with illegal gambling or sexual misconduct or violence, the studentathlete will be immediately suspended, and the suspension may be lifted only by the campus administers. a) First-Time Offenses. Some first-time offenses are serious enough to warrant any of the possible sanctions listed above. b) Multi-Sport Athletes. Multi-sport athletes will not be relieved of any sanction when changing sports. III. c) Underage Alcohol Violation. An underage alcohol consumption violation will be sanctioned at minimum with probation, the terms of which will be determined by Student Affairs. Definition of Team Function A registered student organization, sport club or athletic team function is defined as: Any gathering, whether on- or off-campus, where the intent or reason to gather is to conduct business or engage in any activity related to the organizations purpose, and is organized, arranged or initiated by members of the organization, club or team, or is promoted or communicated using organizational or university resources, such as, but not limited to, e-mail, fliers, social media or any communication at any other organizational function. If any University policies or civil or criminal laws are violated during a function and there is no clear evidence that the sponsoring organization attempted any restraining action through its members or officers, the organization could be held responsible and disciplinary action may be taken. IV. Appeals A student-athlete may appeal sanctions imposed upon him or her by the Mountain Sports Staff. The student may commence appeal through the Mountain Sports Staff or the Director of Campus Recreation, or for more significant offenses, through the Office of Student Affairs. Student Athlete (Sign) Student Athlete (Print) Date

WESTERN STATE COLORADO UNIVERSITY MOUNTAIN TEAMS/PROGRAMS Waiver, Release, Assumption of Risk and Indemnification Agreement READ THIS AGREEMENT COMPLETELY BEFORE SIGNING. BY SIGNING THIS A G R E E M E N T, YOU RELEASE THE UNIVERSITY FROM ANY LIABILITY RESULTING FROM YOUR PARTICIPATION IN THE ACTIVITIES LISTED BELOW AND WAIVE ALL CLAIMS FOR DAMAGES AGAINST THE UNIVERSITY. I, (print name), intend to participate in Mountain Sports (hereinafter the A ctivity ) sponsored by Western State Colorado University (name of sponsor) on the dates specified by my individual club and the Mountain Sports Department. In consideration of Western State Colorado University making arrangements for and permitting and assisting me to participate in this Activity, I agree, for myself, my heirs and assigns, to hold harmless, release, indemnify and forever discharge Western State Colorado University (the University ), its board of trustees, officers, directors, employees and agents and any persons acting on their behalf from and against any and all liability, claims, demands, costs and expenses (including attorneys fees) arising out of or in any way connected with bodily injury or property damage relating to or arising out of my participation in the Activity even if the liability, claims, demands, costs and expenses may arise, in whole or in part, out of the negligence or carelessness of the persons or entities mentioned above. I am aware that the Activity may include certain inherent risks and dangers. I understand that specific risks vary depending on the level and nature of the Activity, and can range from minor personal injuries such as scratches, bruises, and sprains to major injuries such as eye injuries and back or joint injuries to catastrophic injuries resulting in paralysis or death. I understand and assume all the dangers and risks associated with this Activity and waive all claims or causes of action arising out of my participation in this Activity. To the best of my knowledge, I am not aware of any mental or physical disability or health-related reasons or problems that would hinder or otherwise prevent me from safely participating in the Activity. I understand that I am solely responsible for any costs arising out of any bodily injury or property damage sustained through or arising from my participation in the Activity. Personal Vehicle Use In consideration of receiving permission not to be transported in a motor vehicle leased or owned by the University and in furtherance of my request to use transportation of my own choice, I hereby agree, for myself, my heirs and assigns, to release, waive, discharge and covenant not to sue the University, its board of trustees, officers, directors, employees, and agents (hereinafter referred to as the Releasees ) from any and all liability, claims, demands, actions and causes of action whatsoever, arising out of, or related to, any loss, damage, or injury, including death, or other personal injury, that may be sustained by me, or to any property belonging to me, whether caused by the negligence of the Releasees or otherwise, while being transported to or from an athletic event or practice in a motor vehicle not owned by, leased or under the control of the University. I am fully aware of the risks and hazards connected with my transportation, including, the possibility of automobile accidents and the like. I hereby elect to voluntarily be transported in such motor vehicle not owned by, leased or under the control of the University. I attest that I have the proper license, registration and insurance to operate my vehicle and I understand that in the event of an accident I will not be covered by the University s insurance. I voluntarily assume full responsibility for any risks of property damage, personal injury, including, but not limited to death. I further hereby agree to indemnify and hold harmless the Releasees from any loss, liability, damage or costs including court costs and or attorneys fees, that they may incur due to my participation in said transportation, whether caused by the negligence of Releasees or otherwise.

This Agreement shall be governed by and in accordance with the laws of the State of Colorado and venue for any action related to this Agreement shall be in the State of Colorado. I expressly agree that this Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Colorado, and that if any portion herein is held to be invalid or unenforceable, the balance shall continue in full legal force and effect. I have carefully read this Agreement, understand the contents herein, and am executing it voluntarily of my own free will. I have had sufficient time to review and seek explanation of the provisions above, have carefully read them, understand them fully and agree to be bound by them. Nothing in this Agreement shall be construed to waive, limit, or otherwise modify any governmental immunity available to any of the persons or entities released herein under the Colorado Governmental Immunity Act, 24-10- 101, et seq., C.R.S. Mountain Sports Programs: Circle each team/program listed below you will be participating in: Mountain Biking Downhill Mountain Biking Ultra Trail Running Alpine Skiing Nordic Skiing XC Mountain Biking Trail Running Big Mountain Freeride Skiing and Snowboarding Endurance Skiing/SkiMo Other: Print team/program below, if not listed above: Participant Signature: Printed Name: Date: Date of Birth: Age: WSCU ID#: IF STUDENT/PARTICIPANT IS UNDER EIGHTEEN (18) YEARS OF AGE, SIGNATURE OF A PARENT OR GUARDIAN IS REQUIRED. Parent or Legal Guardian Signature: Printed Name: Date: The Following Information to be filled out by the Mountain Sports Staff Only: Staff member name: Checked Photo ID: Approved Date: Waiver was put into a computer:

Western Sate Colorado University Mountain Sports Insurance and Medical Information Form Please provide the information about your primary insurance policy. Student Sport(s) Name of Insurance Company Address City State Zip Code Policy Number Group Number Insured Subscriber Insurance company phone number I understand that I am responsible for and am required to have a primary insurance policy in force while participating in Mountain Sports activities at WSCU. I understand this policy must be in force to participate in any Mountain Sports activity whether the athlete is in season or out of season. I agree that all information provided is accurate and complete to the best of my knowledge. I agree and accept full responsibility for payment of any medical costs associated with Mountain Sports participation at Western State Colorado University. Athlete s Signature Date Parent or Policy Subscriber Signature Date Address / Phone # **Subscriber signature (usually the parent) of this policy is required! STATEMENT OF EMANCIPATION (sign only if student athlete is the subscriber of above policy) I am emancipated and responsible for purchasing and maintaining my own health insurance policy. I acknowledge that I am the subscriber of the above policy. Athlete s Signature Date

Emergency Contact Primary emergency contact (name): Relationship: Primary Phone: Secondary Phone: Email: Secondary emergency contact (name): Relationship: Daytime Phone: Evening Phone: Email: Pertinent Medical History Do you currently have any medical concerns and/or considerations, allergies or medication needs that may inhibit or be exacerbated by your participation in Mountain Sports activities? NO Yes (please explain below) I hereby certify that all of the above information is true and correct to the best of my knowledge. Athlete Name Athlete s Signature Date Parent s Name (if minor) Parent s Signature (if minor) Date