This waiver must be completed by all Campus Recreation & Wellness Participants.
Please complete this Google Form.  This will serve as your signed waiver for all Shenandoah University Fitness Classes, SOAR trips, Intramural Sports, special events, as well as permit you access to any Shenandoah University Fitness Centers.  In addition to this signed waiver, all other rules and policies must be followed.
If you have questions or concerns, please email recsports@su.edu
Email *
INFORMED CONSENT, INDEMNIFICATION AGREEMENT, AND LIKENESS RELEASE (READ CAREFULLY BEFORE SIGNING)
INFORMED CONSENT: I hereby acknowledge my awareness that my participation in Shenandoah University’s Outdoor & Adventure Recreational (SOAR) programs, Intramural Sports, Club Sports, Game Room activities, Welcome Week, VCC Pool usage and activities, and/or Fitness Programs during the 2023 – 2024 Academic Year (August 15, 2023 – July 31, 2024), may involve activities which include, but are not limited to: stretching, running, lifting, jumping, kicking, throwing, swinging, catching, sliding, climbing, swimming, and bodily contact with other people and with recreational and/or athletic equipment.  It may also involve recreational or competitive sports which use various types of athletic equipment which include, but are not limited to: balls, bats, racquets, paddles, helmets, cleats, pads, nets, frisbees, goal posts, sticks, canoes, skis, mats, weights, hoses, dyes, and/or other recreational or athletic equipment.
 
I understand that my participation in the aforementioned activities may expose me to risks of property damage, bodily or personal injury, or exposure to infectious diseases including COVID-19.  This includes injuries/illness that may be fatal, and anyone or more of the following: injury from slipping, tripping and falls; drowning; sickness; foreseen and unforeseen inclement weather; cuts; abrasions and puncture wounds, broken bones; injury from uneven terrain on the fields; injury from contact with animals and plants, other participants and from contact with athletic equipment; muscle strains and sprains; concussions; partial or total paralysis; and heart attack.  If required to travel to/from events and/or travel to participate in activities, I understand that there is a potential for accidents or illness.  In addition, I understand that I may be exposed to other risks that may not be foreseeable. I have been informed and understand that there are inherent risks and dangers involved in this activity. I knowingly and freely assume any and all such risks and voluntarily participate in this activity.  I understand that it is my responsibility, as a participant, to engage only in those activities for which I have the prerequisite skills, qualifications, preparation, and training.

I acknowledge that I must follow the instructions of the activity leader and game officials and adhere to university and facility policies, procedures, and/or protocols at all times.  In addition, I understand that Shenandoah University does not provide insurance coverage for my participation in Shenandoah University’s Intramural Sports, Club Sports, Fitness, Recreation, Aquatics, Welcome Week, and (SOAR) Programs during the 2023 – 2024 Academic Year and that it is strongly recommended that I obtain my own accident and health insurance prior to participating.

INDEMNIFICATION AGREEMENT:  I further covenant and agree that in consideration for my right to participate in any of the activities described above, I will indemnify and forever hold harmless Shenandoah University, its subsidiaries, and any of their trustees, officers, and employees (“SU Indemnitees”), for any claim for damages arising or growing out of my participation in any of these activities unless any of the damages were caused by the negligence, gross negligence or intentional misconduct of one or more SU Indemnitees.  
 
LIKENESS RELEASE: As a condition of my participation, I hereby grant Shenandoah University the right to use, for promotional purposes only, any photographs or videos of me taken by Shenandoah University, its employees or agents, during my participation in the Program. I further understand and agree that Shenandoah University may use (for marketing purposes) any statements or quotes attributed to me in my evaluation of the Program.  I hereby waive the right to inspect or approve my image or any finished materials that incorporate my image.  I understand and agree that my image will become part of the University’s photograph file and that it may be distributed to other organizations or individuals for use in publications.  I also understand that I will receive no compensation in connection with the use of my image.

SU ID Number *
First Name *
Last Name *
Anticipated Graduation *
Cell Phone Number *
SU Email Address *
Emergency Contact Name *
Emergency Contact Phone Number *
Please read the Concussion Fact sheet below and select your answer below *
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I certify that I have read the INFORMED CONSENT, INDEMNIFICATION AGREEMENT, AND LIKENESS RELEASE listed at the start of this form. *
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