Waiver of Liability, Assumption of Risk, and Indemnity Agreement
Midwinter Ball, Carleton College, Northfield, MN | Saturday, February, 4, 2023
Student Activities Office | (507) 222-4462
Representations: I wish to voluntarily participate in the Carleton College above referenced Activity. I represent that I am in good health and in proper physical condition to safely engage in the Activity. I agree that it is my sole responsibility to determine whether I am sufficiently fit and healthy enough to participate in the Activity. In the Activity of injury or illness during my participation in the Activity, I authorize Carleton and the Activity Organizers to administer and/or secure medical treatment on my behalf, and I agree to accept responsibility for the full expense of such medical care along with other related expenses such as ambulance transportation.
Assumption of Risk: I understand and acknowledge there will be known and unknown risks, dangers, and hazards, which may be encountered in the above mentioned Activity and that accidents and injuries commonly happen, often without fault on the part of the participants or the Activity Organizers. The specific risks vary from one activity to another, but the risks range from 1) minor injuries such as loss of personal property, scratches, bruises, and sprains 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 3) catastrophic injuries including car accident, paralysis and drowning.
I understand that these risks may be caused in whole or in part by my own actions or inactions, the actions or inactions of others participating in the Activity, or the acts, inaction or negligence of the Released Parties defined below, and I voluntarily assume any and all risks and responsibility for any damages, liabilities, losses or expenses which I incur as a result of my participation in the Activity.
RISK OF CONCUSSION: As a legal adult responsible for choosing my healthcare, I have the direct responsibility for immediately reporting all of my injuries and illnesses to the sports medicine staff of my institution (e.g., team physician, athletic training staff), Campus Security, or the College Risk Manager. I recognize that my true physical condition is dependent upon an accurate medical history and a full disclosure of any symptoms, complaints, prior injuries and/or disabilities experienced. I hereby affirm that I have fully disclosed in writing any prior medical conditions and will also disclose any future conditions to the sports medicine staff or Carleton’s Risk Manager.
I further understand that there is a possibility that participation in The Activity may result in a head injury and/or concussion and a concussion is a potentially serious head injury that can result in severe consequences if not taken seriously from the start. I understand that I will not return to play (in practice or games) or other activities if experiencing concussion-like signs and symptoms following a blow to the head or body and that a repeat concussion is more likely when a student returns to play before symptoms resolve. I understand that helmets, face shields, mouth guards and other protective equipment does not eliminate the risk of concussions and that purposeful head and neck contact in any sport is not permitted. I agree that I will immediately report to medical staff if my child observes a teammate suffering from any suspected signs and symptoms of a concussion. I acknowledge that the institution has the authority to permanently retire a student athlete/participant from sports or similar activities if it determines the risks of concussive injury while playing present a serious threat to my safety and well-being. When relevant, I have been provided with education on head injuries and understand the importance of immediately reporting symptoms of a head injury/concussion to my sports medicine staff or Carleton’s Risk Manager.
Insurance Coverage: I understand that Carleton does not undertake to provide health, accident, disability, hospitalization, personal property, or other insurance to participants in the Activity. I affirm that I have appropriate medical insurance in the Activity medical attention is needed for me by reason of my participation in the Activity.
Waiver of Liability: In consideration of being permitted to participate in the Activity, I hereby release, discharge and agree to hold harmless Carleton (including but not limited to the Activity Organizers), Carleton’s trustees, officers, faculty members, employees, agents, advisors or any one or more of them, or their executors, administrators, heirs or assigns (the “Released Parties”) from any and all claims, demands, damages, costs, expenses, actions and causes of action, present or future, on account of injuries to my person or property caused in whole or in part by the active or passive negligence of the Released Parties, arising out of or in connection with my participation. I intend for this release and indemnity agreement to protect the Released Parties from any and all claims, demands, damages, costs, expenses, actions and causes of action, present or future, of my executors, personal representatives, heirs and assigns, or any other person or entity, on account of injuries to my person or property, including injuries resulting in my death. I also recognize and agree that the Released Parties assume no responsibility for any liability, damage, or injury that I might sustain due to the intentional or negligent acts or omissions of any other person participating in the Activity.
Indemnification and Hold Harmless: In further consideration of my being permitted to participate in the Activity, I, for myself and for my executors, personal representatives, heirs and assigns, hereby assume full responsibility for the risks, foreseen or unforeseen, of property damage, injuries, or death to myself or to others arising out of my participation. I agree to indemnify and hold harmless the Released Parties from all claims, demands, damages, costs, expenses, actions and causes of action, present or future, including but not limited to costs of medical treatment and reasonable attorneys’ fees, that may accrue to any person or entity as a result of any property damage, injuries, or death, caused by me or arising out of my participation in the Activity.
Severability: I expressly agree that the foregoing waiver and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of Minnesota and that if any of its provisions are held to be invalid, the balance shall, notwithstanding, continue in full legal force and effect.