Waiver of Liability Form

All members of club teams MUST fill out a waiver of liability form and show proof of insurance before practicing or playing with a Luther College club team.

* = required field

Club Team:*
Name:*
Age:*
Student ID#:*
Year in School:*
Campus Address:*
Home Address (street, city, state):*
I am aware that playing or practicing to play/participate in any sport can be dangerous activity involving MANY RISKS OF INJURY. I understand that the dangers and risks of playing or practicing to play/participate in ultimate frisbee or rugby include, but are not limited to, death, serious neck and spinal injuries or impairment to other aspects of my body, general health and well-being. I understand that the dangers and risks of playing or practicing to play/participate in the above sport may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities, and generally to enjoy life. I understand that Luther College shall assume no responsibility or liability for me for accident or illness, and I acknowledge and do hereby assume all risks inherent in the play/participation in the sport of ultimate frisbee or rugby, and I hereby hold Luther College and its respective officers, employees, agents and representatives harmless from any and all liability, action, claims, and damage of every kind and nature whatsoever including negligence.
Please indicate that you have read and understand the above statement
My signature on this document is also intended to bind my heirs, representatives, executors, administrators, successors, and assigns. I am at least 18 years of age and have read this release and understand all its terms.
Full Name:*
Acceptance/Decline the Risks Involved in Playing a Club Sport*
Date:*
I understand that it is necessary to have medical insurance in order to play. The name of the company that I am insured with and the policy number are following:
Insurance Company:*
Policy Number:*