RELEASE OF LIABILITY WAIVER and STATEMENT OF ASSUMPTION OF RISK - Tag & Fitness


This release and statement is provided to SB Tchoua Consulting Ltd (“SBC”) for its Rugby Fitness program and to all coaches, staff, directors and other representatives, members and agents of such entity (collectively “SBR team”).

First Name  Last name   Birth date:  

Address

Phone   Email  


I am aware that trying out, practicing, playing or any other form of participation in any sport or athletic activity including rugby, tag-rugby, touch-rugby can be dangerous and that participation involves MANY RISKS OF INJURY.

 

I understand that the dangers and risks engaging in athletics, including rugby include but are not limited to death serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all bones, joints ligaments muscles tendons and other aspects of the musculoskeletal system and serious injury and impairment to other aspects of the body, health and well-being.

 

I also understand that the dangers and risks of engaging in athletics including rugby may result not only in serious injury but also in a serious impairment of my future abilities to earn a living and to engage in business and social activities and generally enjoy life.

 

Because of the risk described above, I recognize the importance of listening to and following all the coaches’ instructions and warnings regarding playing techniques, training methods, tackling techniques, rules of the sport and other team rules. I also recognize the importance of adhering to all written instructions and written warnings regarding playing techniques, training methods, tackling techniques, rules of sport and other team rules. I understand that all instructions and warnings, verbal or written, are incorporated by references into this waiver and hereby expressly promise to obey all such instructions and warning.

 

In consideration of SBC permitting me to practice, play or any other way participate in athletics, including rugby, tag-rugby, touch-rugby, I HEREBY VOLUNTARY ASSUME ALL RISKS AND HAZARD ASSOCIATED WITH SUCH PARTICIPATION, I AGREE TO WAIVE ALL CLAIMS OF WHATEVER NATURE, fully and finally, now and forever, for myself, my estate, my heirs, my administrators, my executors, my assignees, my successors and for all members of my family and to release, exonerate discharge and hold harmless SBC, its officers, agents, employees, its staff, all coaches, assistant coaches, physical education teachers, athletics trainers from any and all liability, claims, causes of action or demands arising out of any injuries to my person, or to any third party participating to SBC's Rugby Fitness program which may result from or occur in connection with my participation in SBC ‘s Rugby Fitness program.

 

I specifically acknowledge that certain sports, including rugby, are more high risk and may contain VIOLENT CONTACT involving even greater risk of injury that other sports and I both understand and I VOLUNTARY ASSUME ALL OF THOSE RISKS.

 

Even if I confirm that I am in good physical condition and have no medical impairment that might prevent me from practicing today, I do hereby request, authorize and consent to accepting emergency care/ treatment or first aid as may be needed by any available physician or licensed health care practitioner, any medical treatment facility/hospital, coach or “good Samaritan” and do hereby agree to indemnify and save harmless these individuals and SBC from any claim by any person whatsoever on account of such care and treatment.

 

 


MEDIA AUTHORISATION

Photos and videos will be taken throughout the SBC ‘s Rugby Fitness program. Some photographs will be posted on our website, facebook, newsletter and for commercial purposes. Please let us know in writing if you do not wish your picture made public (contact@sergebetsenrugby.com).

 

 

 

 

 

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: RELEASE OF LIABILITY WAIVER and STATEMENT OF ASSUMPTION OF RISK - Tag & Fitness
lock iconUnique Document ID: 6e570c78c4bf524fa701c85ca82277c049afb195
Timestamp Audit
April 5, 2017 3:40 am BSTRELEASE OF LIABILITY WAIVER and STATEMENT OF ASSUMPTION OF RISK - Tag & Fitness Uploaded by Helene CAUX Betsen - contact@sergebetsenrugby.com IP 2a02:c7d:b991:9700:6cc0:e6f2:20f3:88d1