As a voluntary participant in the ___HOCKEY CLUB____. I recognize and acknowledge that there are certain risks of physical injury including, but not limited to death which may arise from accidents or other causes. Notwithstanding any instruction or consultation by the University of Chicago, or the University of Chicago Medical Center, I agree to assume responsibility for any such injuries, damages or loss which I may sustain as a result of participating in any and all activities connected with or associated with the Activity except if caused by the sole negligence of the University of Chicago or the University of Chicago Medical Center (School).
I understand that School rules will be enforced. If I violate these rules, as determined by the School, I will not be able to continue participation in the Activity.
I certify that I have considered my personal medical condition, allergies or other special dietary needs that might expose me to injury as a result of my participation in the Activity.
I understand that the School does not provide medical insurance to me outside of coverage that is provided under my own medical insurance policy (coverage may include any coverage provided under USHIP or other medical insurance paid for by me and provided through the School). I certify that I have adequate medical insurance to pay for any medical services that may be required while I am participating in the Activity. In the absence of medical insurance, or to the extent my medical insurance does not provide sufficient coverage, the foregoing waiver and release of the School shall include waiver and release of payment of medical bills incurred as a result of my participation in the Activity. I agree that any additional costs are my responsibility.
I acknowledge that my participation in the Activity is voluntary. In consideration of my participation in the Activity, I agree to assume all risks and responsibilities surrounding my participation in the Activity including transportation to and from the Activity, and hereby release, waive, forever discharge the School, its trustees, directors, officers, agents, and employees, from and against any and all liability for any harm, injury, damage, claims, demands, actions, causes of action, costs and expenses of any nature which I, my spouse or my family have, arising out of or related to any loss, damage, or injury, including but not limited to falls from heights, sprains/strains contusions, fractures, hypothermia and possible death, that may be sustained or by any property belonging to me, except to the extent caused by the sole negligence of the School.
I have signed the Waiver and Release in full recognition and appreciation of the dangers, hazards, and risks of the Activities including but not limited to injuries as a result of Physical body contact with other players, referees, the boards, the ice, and the nets during the course of play, any of which may be incidental, coincidental, and injuries to the head, eyes, teeth, face, hands, wrists, elbows, shoulders, ribs, organs, hips, knees, ankles, feet, back and spinal cord, or other body parts, including broken bones, cuts, dislocations, sprains, muscle tears, bruises, bleeding and death. I understand it is my responsibility to educate myself on the risks associated with the Activity. In signing this Release, I acknowledge and represent that I fully understand the content of this Release. I have reviewed it and understand what it means, and that I sign this document freely. No oral representations, statements, or inducements, apart from the foregoing written statement, have been made. I understand that the School does not require me to participate in this Activity, but I want to do so, despite the possible dangers and risks and despite this Release. I understand that I am responsible for further educating myself on the specific risks of the Activity as arranged under the Program.
I further agree that this Release shall be construed in accordance with the laws of the State of Illinois. If any term or provision of this Release shall be held illegal, unenforceable, or in conflict with any law governing this Release, the remaining portions shall not be affected thereby.
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