NC State University Recreation Health and Safety Course Registration
NC State University Recreation Health & Safety Courses are exclusively for NC State Students, Carmichael Members, Faculty and Staff
Additional American Red Cross Courses can be found at the redcross.org under Training and Certifications
Name (First, Last)
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Age
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If Under 17, Please List Guardian
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NC State University Affiliation
NC State University ID #
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Phone
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Email
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Health and Safety Course Selection
*The Lifeguard Recertification requires a current Lifeguard Training Certification
How Did You Hear About This Opportunity
Emergency Contact Name
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Phone
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Relationship to Participation
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INFORMED CONSENT, ASSUMPTION OF RISK, RELEASE, AND HOLD HARMLESS AGREEMENT
Thank you for choosing to use the activities, programs or services at NC State University Recreation. We request your understanding and cooperation in maintaining your safety and health by reading and signing the following INFORMED CONSENT, ASSUMPTION OF RISK, AND HOLD HARMLESS AGREEMENT. I declare that I and any child that I am responsible for intend to use some of all of the activities, facilities, programs and services (Herein after called “Activities” offered by NC State University Recreation and I understand that all Activities offered are educational, recreational, or self-directed in nature. I assume full responsibility for myself and my child during and after participating in such Activities and for all choices to use or apply at one’s own risk, any portion of the information or instruction I or my child receive. I understand that part of the risk involved in undertaking any of the Activities is relative to one’s own state of fitness or health (physical, mental or emotional) and the awareness, care and skill with which one conducts themselves in any of the Activities of NC State University Recreation. In addition, I understand that I and my child are free to withdraw from, reduce or modify the involvement in any of the activities and I realize that I and my child should do so on recognition of any signs of physical discomfort which may include: transient lightheadedness, fainting, chest discomfort, leg cramps, nausea, etc. I further understand that the possible risks involved in participating in an instructional program may include: transient lightheadedness, fainting, chest discomfort, leg cramps, nausea, etc. I further understand that the possible risks involved in participating in an instructional program may include, but are not limited to: muscle, tendon, ligament, bone and joint soreness, muscle tendon and ligament strain, tear or rip, bruising, skin lacerations, tears, cuts or punctures, shortness of breath, dizziness, fainting or unconsciousness, sweating, eye punctures, heart attack, stroke, or even death, aggravation of an existing or past injury, discomfort, or problem with any other injury, discomfort or physical problem associated with physical activity. I have read and understand the above list of possible risks associated with the instructional program developed and implemented by an approved instructor employed by NC State University. Participation in University Recreation activities at NC State University involves potential risk of physical injury. Persons participating in recreational activities at NC State University involves potential risk of physical injury. Persons participating in recreational activities at NC State University are strongly recommended to acquire their own personal health insurance since the university does not carry health or accident insurance to cover injuries and medical care for these individuals. I further understand that treatment for any medical problems my child may suffer is my responsibility and will be paid for by me and/or covered by my insurance. In addition, it is strongly encouraged that participants consult with their physician and to reduce the potential for injury by stretching adequately before and after any activity. I consent to taking all of the above noted risks by VOLUNTARILY PARTICIPATING in the instructional program designed and implemented by an approved instructor employed by NC State University Recreation. I shall indemnify and hold harmless NC State, its trustees, officers, employees and agents from any liability, losses, costs, damages, claims or causes of action of any kind or nature whatsoever, and any expenses, including attorney’s fees, arising from or proximately caused by my child’s participation in this program, including any travel. I further agree to accept and assume for myself my assigns, executors, and heirs any and all such risks and losses that may occur. By clicking submit, I declare that I have read, understood and agree to the contents of this INFORMED CONSENT, ASSUMPTION OF RISK, RELEASE AND HOLD HARMLESS AGREEMENT in its entirety and agree to be bound by it.
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