Rec Clubs Code of Conduct/Liability Waiver

This is the Rec Clubs Code Of Conduct/Liability Waiver. 

Each member of a Rec Club is required to fill out a Code of Conduct/Liability Waiver that is valid for the current academic school year (July 1st thru June 30th).

Please be sure to E-Mail the Rec Club(s) you are interested in joining via our CLUB CONTACT LIST that is found on our website.

This registration must be completed FOR EACH CLUB before actual participation begins. Before filling out the form, please understand the following:

1. ) In order to be a part of a club, YOU must be an active student at Portland State University taking at least 1 credit and be paying student fees. If you are unsure of your status as a student, please contact the PSU Registrations Office.

2.) Clubs are not allowed to have community members be club members unless granted special approval from the Rec Clubs Coordinator.  Many clubs have opportunities for community participation during special events.  These special events must be planned a minimum of a month in advance and have Rec Club Coordinator approval.  Special events are defined as any activity outside of the clubs normal practice and league game or event schedule. 

3.) Please note that certain clubs may have limits on participation and/or membership due to competitive team size, national governing body rules, resource restrictions, etc.

Once you begin this form, you must finish it and hit submit in order for it to be approved. Any submitted form that is incomplete will be considered VOID.

Email *
FULL NAME *
EMAIL ADDRESS *
PHONE NUMBER *
STUDENT ID NUMBER *
CLUB NAME *
AGE (Optional)
GENDER (Optional)
YEAR IN SCHOOL (Optional)
WHERE DID YOU HEAR ABOUT REC CLUBS? *
EMERGENCY CONTACT NAME *
EMERGENCY CONTACT PHONE NUMBER
*
YOUR RELATIONSHIP TO EMERGENCY CONTACT
*
CODE OF CONDUCT

The Code of Conduct Agreement serves as a guideline for how individuals are expected to behave when participating in Portland State University Rec Clubs sponsored or endorsed activities. All club members participating in an event sponsored or endorsed by Portland State University are representing their club and Portland State University at all times.

*Please READ each bullet point and initial at the bottom.*

As a Rec Clubs participant in the Portland State University Rec Clubs program, I agree to abide by the following:

1.) I am a currently enrolled student, alumni, or faculty/staff at Portland State University.

2.) I accept that participation in Rec Clubs is an opportunity and a privilege, not a right. I will ALWAYS adhere to the rules established by Rec Clubs, Campus Recreation and Portland State University.

3.) I understand that alcohol, drugs and illegal substances are not part of the Rec Clubs program. I will not engage in the use, possession, or distribution of alcohol, drugs, or illegal substances while traveling, competing, socializing and/or using facilities including lodging spaces.

4.) I am a dedicated contributing member of my club. I understand my level of dedication has an effect on the overall success/status of the club.

5.) I will not participate in any hazing or initiations while participating in the Rec Clubs Program. I understand that compromising an individual will not be tolerated. If I have any question about hazing and initiations I will contact the Rec Clubs Coordinator.

6.) I understand my financial responsibility to my club and will pay club dues on time. I am aware that failure to return club property and fulfill my financial responsibility can result in my club falling into bad standing with the RCC (Rec Clubs Council).

7.) If I become an official Rec Clubs driver I will adhere to all travel policies. This includes drivers training.

8.) When I participate in an event or club activity, I accept the responsibility of representing Portland State University in a way that will not detract from the reputation of the institution or violate behavior of any sort which would reflect negatively on the image of the Portland State University, Campus Recreation, and/or the image of my club.

9.) I will respect all Campus Rec employees, competition officials, spectators, Portland State employees, opposing team members and their administration.

10.) As a Rec Club participant I understand the roles of my Rec Club Officers and Safety Coordinators. If I do not understand their roles, I will ask them for clarification on their responsibilities with my club.

By checking below, I declare that I have read and accepted the above terms and conditions in the REC CLUBS CODE OF CONDUCT.
*
Required
LIABILITY WAIVER

PARTIES & CONSIDERATION 

I, ________, voluntarily wish to participate in PSU Campus Recreation Activities (“Activities”). In consideration for being permitted to participate in the Activities, I hereby agree and warrant that:

STATEMENT & ASSUMPTION OF RISK
I certify that I am physically capable of participating in the Activities. I certify that I have neither a condition nor circumstance, such as medication, that would prevent me from participating in these Activities. Participation in the Activities can be hazardous to my health. I understand that I have an increased chance of suffering personal injury, including but not limited to bodily harm, permanent disability, dismemberment, and/or death by participating in the Activities. I understand that traveling to and from the Activities site may present additional risk of serious injury or death, and agree to comply with Activities requirements for the use of seatbelts by vehicle passengers during travel.
I voluntarily undertake the Activities and agree to take responsibility for my physical fitness to perform Activities, assume responsibility for safety while participating and accept all risk associated with my participation.

RELEASE OF LIABILITY AND INDEMNIFICIATION STATEMENT
I understand that there are unavoidable risks involved with participation in these Activities, and I, individually, and on behalf of my heirs, successors, assigns, and personal representatives, hereby agree to defend, indemnify and hold harmless and release and forever discharge the State of Oregon, the Oregon Board of Higher Education, the Oregon University System, PSU, and their officers, employees, agents, and representatives, from any and all liability and all claims and causes of action whatsoever for any damages to or loss of property, personal illness, or injury (including death) caused by, deriving from, or associated with my participation in the Activities.

MEDICAL TREATMENT CONSENT
I fully understand that the Activities may occur in a remote area and that medical services may not be available. In the event of illness or injury to me, and in the event that medical services can be obtained, and if I am unable to grant permission at the time emergency treatment is required, I hereby authorize PSU by and through its authorized representative(s) or agent(s), if any, to secure any necessary treatment including the administration of an anesthetic and surgery.

STATEMENT OF INSURANCE
I am aware that the State of Oregon does not provide medical insurance coverage for participation in the Activities and therefore take full responsibility for procuring my personal insurance. If I do not have insurance, I accept full, sole and exclusive financial responsibility for the cost associated with any injury or illness.

FUTHERMORE

 I understand that PSU may not have a representative(s) or agent(s) present at these Activities and the Activities may be solely student-operated.

 I agree to abide by the policies of PSU while engaged in the Activities, and, if I am a student, with all the provisions of the Student Code of Conduct. I further agree to comply with all safety rules and procedures presented during the Activities.

 I understand that PSU’s authorized representative(s) or agent(s) has authority to revoke my participation in the Activities at any time if, in the judgment of the representative(s) or agent(s), my actions or general behavior are determined to be unacceptable.

 In the event of an injury or death that occurs during my participation in the Activities, I hereby waive my rights of nondisclosure under the Family Educational Rights and Privacy Act, ORS 351.070(4)(e) and any other statutes or rules, and hereby consent to the release of this Agreement to the media, public or any others who inquire.

 I am aware that the Rec Center and its users are photographed on occasion to promote Campus Rec. I understand that this release acts as my photo release for Campus Rec to use my photo in promotional materials. Should I not wish to have video or photos of me taken, I will notify the photographer/videographer on site.

CHOICE OF LAW; VENUE SELECTION

In event of a law suit, I agree that all causes of action will be filed in Multnomah County, Portland, OR and that this Agreement shall be construed in accordance with the laws of the State of Oregon.

SEVERABILITY

If any term or provision of this Agreement shall be held illegal, unenforceable, or in conflict with any law governing this Agreement the validity of the remaining portions shall not be affected thereby.

FINAL ACKNOWLEDGMENT

I, _________, confirm that I execute this document with full knowledge of the contents and consequences stated in this release. Parent or Guardian Indemnification and Release (If Participant is a non-student under the age of 18) I am the parent or legal guardian of the minor participant (“Minor”) named above. I consent to the Minor taking part in the Activities. In consideration of Minor being permitted by the department and/or program noted above to participate in its Activities or use its equipment and facilities, I further agree, in my individual capacity and on behalf of Minor, to indemnify and hold harmless and release and forever discharge the State of Oregon, the Oregon Board of Higher Education, the Oregon University System, PSU, and their officers, employees, agents, and representatives from any and all claims brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.

By checking below, I declare that I have read and accepted the above terms and conditions in the Assumption of Risk, Release, Indemnification and Participation Agreement (Liability Waiver).
*
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Portland State University. Report Abuse