Healthy Hornet Registration Form

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Waiver of Liability and Release Statement

Individual participants should be duly aware of the risks and hazards involved when participating in recreation and fitness activities. Participation is voluntary and this signed waiver serves to provide as an informed consent, whereby the individual signing the waiver chooses to utilize ESU facilities and/or equipment and/or participate in programs and services provided by the Recreation Services department, the Department of Health, Physical Education and Recreation, the Student Wellness Center and Human Resources. In consideration of said voluntary participation, the undersigned agrees to assume all risks of loss, damage, or injury that may be sustained while using ESU facilities and/or equipment and/or participating in programs and/or services. These injuries may range from a slight bruise or scratch to broken bones, internal injuries that could cause brain damage or paralysis, injuries to the spine that may cause quadriplegia, and other types of catastrophic injuries that may even result in death. Furthermore, the Recreation Services department, the Department of Health, Physical Education and Recreation, the Student Wellness Center and Human Resources assumes no responsibility for costs incurred with individual injury or property damage related to the use of university facilities and/or equipment and/or participation in programs and/or services. Individuals are reminded that they should review his/her own personal circumstances to determine if he/she has adequate health and accident insurance to protect against financial loss should participation result in serious injury. It is recommended that all participants have a physician’s approval before engaging in any physical activity. As verified by my checking the liability release box above, I hereby release the State of Kansas, the Kansas Board of Regents, Emporia State University, the Recreation Services department, the Department of Health, Physical Education and Recreation, the Student Wellness Center and Human Resources and their respective employees, interns, practicum students, and volunteers from all liability based upon negligence or any other cause for any loss, damage, or injury incurred in relation to use of university facilities and/or equipment and/or through participation in any Recreation Services department programs, the Department of Health, Physical Education and Recreation, the Student Wellness Center and Human Resources activities or services.|Individual participants should be duly aware of the risks and hazards involved when participating in recreation and fitness activities. Participation is voluntary and this signed waiver serves to provide as an informed consent, whereby the individual signing the waiver chooses to utilize ESU facilities and/or equipment and/or participate in programs and services provided by the Recreation Services department, the Department of Health, Physical Education and Recreation, the Student Wellness Center and Human Resources. In consideration of said voluntary participation, the undersigned agrees to assume all risks of loss, damage, or injury that may be sustained while using ESU facilities and/or equipment and/or participating in programs and/or services. These injuries may range from a slight bruise or scratch to broken bones, internal injuries that could cause brain damage or paralysis, injuries to the spine that may cause quadriplegia, and other types of catastrophic injuries that may even result in death. Furthermore, the Recreation Services department, the Department of Health, Physical Education and Recreation, the Student Wellness Center and Human Resources assumes no responsibility for costs incurred with individual injury or property damage related to the use of university facilities and/or equipment and/or participation in programs and/or services. Individuals are reminded that they should review his/her own personal circumstances to determine if he/she has adequate health and accident insurance to protect against financial loss should participation result in serious injury. It is recommended that all participants have a physician’s approval before engaging in any physical activity.


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