Insurance Liability Consent Form:

I am aware that participating in the sport of Men's Soccer can be a dangerous activity involving MANY RISKS OF INJURY. I understand that the dangers and risks of participating in the sport of soccer may include serious bodily injury, which may include loss of limb or impaired organ, loss of sensory function (i.e. sight, hearing…) permanent physical impairment (i.e. paralysis) or even death. I assume the risk of participation in the Men's Soccer Alumni Game. I have had the opportunity to ask questions and such questions, if any, have been answered to my satisfaction.

I waive any responsibility on the part of Elmira College, the Department of Athletics and its Men's Soccer staff, athletic training staff, the College Health Center and its medical staff, and any medical facilities or doctors designated by the aforementioned staffs for illness or injuries that develop while participating in the Men's Soccer Alumni Game at Elmira College and agree to defend, indemnify, and hold them harmless from any claims, liabilities or reasonable expenses resulting therefrom.

I also understand that any medical services necessitated by my participation in the above indicated alumni game will be charged to my/my family’s insurance plan. The Elmira College Athletic Injury Insurance plan does not cover injuries/illnesses while participating in the Men's Soccer Alumni Game.

I further certify that I have read and understand the above statements and that the information provided is truthful to the best of my knowledge.