March 16, 2022

Participant Information / Medical Consent & Release - Minor

  • Please choose the program you are submitting this form to.

  • Minor - Medical Consent & Release Form

  • I hereby certify and agree that:
  • (hereinafter, “My Child”) has my approval to participate in the URI Summer Sailing Lesson program (hereinafter “the Activity”) to be held at the URI Sailing Center.

    I know the nature of the Activity and My Child’s experience and capabilities and consider My Child to be qualified to participate in the Activity. However, I acknowledge that there are certain risks of physical injury or illness associated with the Activity.

    In return for My Child’s participation in the Activity: I fully and forever RELEASE, WAIVE, DISCHARGE, ACQUIT, INDEMNIFY, HOLD HARMLESS and COVENANT NOT TO SUE, University of Rhode Island Board of Trustee, The University of Rhode Island and their agents and volunteers (hereinafter collectively referred to as “the University”) from any and all liabilities, claims, or injuries, including death, that may be sustained while participating in this activity, including but not limited to travel to, from, and for the activity, or while on premises owned or controlled by the University. I understand this release does not apply to injuries caused by intentional or grossly negligent conduct on the part of the University. I further agree to indemnify and hold harmless the University for any loss, liability, claim or injury caused by me (My Child) while participating in this activity including traveling to, from, and for the activity, or while on premises owned or controlled by the University.

    I recognize that the University does not assume responsibility for or liability for - including costs and attorney’s fees - any accident or injury or damage resulting from any aspect of participation in the Activity. The University is not liable for any special, incidental, or consequential damages arising out of or in connection with any aspect of participation in the Activity.

    I also give permission for My Child to receive any emergency medical treatment by a healthcare professional, including emergency medical transportation, which may be required for injuries sustained by My Child. However, I agree that the University (including, but not limited to, each of the University’s regents, boards, agents, employees, officers or representatives) are not responsible for any medical bill incurred as a result of any personal illness or injury to My Child, even if the University has signed hospital documentation promising to pay for the treatment. That medical bill is my responsibility.

    I understand that by signing this document, I give up substantial rights that I or My Child would have otherwise to receiver damages for any loss occasioned by the University’s fault, and I sign it voluntarily and without inducement.

  • By agreeing electronically, you acknowledge that you have both read and understood all text presented to you in this form.
  • YOUR SIGNATURE INDICATES COMPLIANCE WITH URI CAMPUS RECREATION ASSUMPTION OF RISK AND RELEASE OF LIABILITY FORM

  • Medical Insurance Information

  • Emergency Contacts

  • NameRelationshipPhoneCell 
    Please list anyone you would like the URI Campus Recreation staff to contact in the event of an emergency situation.
  • NameRelationshipPhoneCell 
  • NameRelationshipPhoneCell 
  • NameRelationshipPhoneCell 

  • Participant's Health History

  • Is there anything else we should know about? If so, please describe above, or state "NONE"
  • The Department of Campus Recreation reserves the right in its sole discretion to decline any participants for safety reasons.

  • Serious Allergies

  • Does the participant have any serious allergies?
  • AllergyDescribe reaction & management of reaction 
  • AllergyDescribe reaction & management of reaction 
  • AllergyDescribe reaction & management of reaction 
  • AllergyDescribe reaction & management of reaction 
  • AllergyDescribe reaction & management of reaction 
  • AllergyDescribe reaction & management of reaction 
  • If participant requires medication for allergic reactions, please bring one dose and the participant must present information to URI Campus Recreation approved personnel at check-in of the first day.

  • I CERTIFY THAT THE ABOVE INFORMATION IS TRUE, CORRECT, AND COMPLETE
  • By agreeing electronically, you acknowledge that you have both read and understood all text presented to you in this form.
  • YOUR SIGNATURE INDICATES COMPLIANCE WITH URI CAMPUS RECREATION MEDICAL CONSENT AND RELEASE POLICIES AND PARTICIPANT HEALTH HISTORY

  • Assumption of Risk and Release of Liability Form

  • In consideration of my voluntary participation in URI's Department of Campus Recreation's programs and facilities:
  • I confirm my participant (for him/herself, his/her parent or legal guardian, his/her heirs, representative, executors, administrators, successor or assigns) hereby waives, releases, fully discharges and quitclaims unto The University of Rhode Island Board of Trustees, The University of Rhode Island, and the State of Rhode Island and their agents and employees from any and all liability and claims, or demands and/or action, that he/she has or may have for any costs, expenses, or damages, including reasonable attorneys’ fees, arising from property damages or personal bodily injury, including death, relating to or arising from my participation in, use of, or operation of equipment related to the Activities or may in the future have, whether known or unknown, arising out of the Activity.
  • I may or may not have had previous participation experience in the Activity. I understand and acknowledge that such participation could result in loss of or damage to my or another person's property, serious injury to my body, including mental or emotional injury or trauma and/or death. I verify that I have no physical or emotional conditions, which may prevent me from fully participating in the Activity.
  • I understand and agree The University of Rhode Island and its recreational subsidiaries cannot be expected to control all possible risks but may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required during an attendance with the understanding that cost of any such treatment will be my responsibility. The University does not carry medical or accidental insurance for the activities mentioned. As such, participants should review their personal insurance portfolio.
  • I HAVE READ THE WAIVER, RELEASE AND ASSUMPTION OF RISK FORM IN ITS ENTIRETY AND UNDERSTAND THE TERMS AND LEGAL SIGNIFICANCE. This waiver is freely and voluntarily given with the understanding that right to legal recourse is knowingly given up in return for allowing my participation in the Activity.
  • By signing below, I agree that I have read and understand the above information.
  • By agreeing electronically, you acknowledge that you have both read and understood all text presented to you in this form.
  • YOUR SIGNATURE INDICATES COMPLIANCE WITH URI CAMPUS RECREATION ASSUMPTION OF RISK AND RELEASE OF LIABILITY FORM

  • Acknowledgement of Participation Information, Authorization And Release

  • 1. PARTICIPATION: In consideration for my voluntary participation at URI Campus Recreation, I hereby acknowledge that I am in good physical and mental health and that unless I have notified the University in writing that I am unable to aprticipate in the activity due to some physical or mental consideration, I will be allowed to participate in all aspects of URI Campus Recreation.
  • 2. PHOTOGRAPHS/VIDEOS/SOCIAL MEDIA PERMISSION: I may be photographed (stills and videos), individually or in a group. We hereby waive and relinquish all rights, title and interest in all such products, and authorize URI Campus Recreation authorized staff to make use of participant's images and likeness for marketing, membership information, and other URI Campus Recreation uses.
  • 3. BEHAVIORAL MANAGEMENT: There are three basic rules that are easy to understand and follow: BE SAFE, BE KIND, AND PARTICIPATE. We want to foster responsibility, respect, and accountability at URI Campus Recreation so our approach to discipline will reflect this goal. Any discipline will be: constructive in nature, using limits that are fair, consistently applied and understandable for the student. Campus Recreation Coordinators will communicate with the student if deemed necessary. if the student continuously displays inappropriate behavior or engages in dangerous activities, the Campus Recreation Coordinator and the Department of Campus Recreation authorized personnel reserve the right to suspend any participant, at any time, without a refund.
  • 4. TRANSPORTATION: URI Campus Recreation authorized personnel are not permitted to transport participants by car (or any other type of land transportation), to and/or from, any off-site activities; and/or in an event of a medical emergency.
  • 5. POLICIES & PROCEDURES: I understand and agree to adhere to all policies and procedures set forth by The University of Rhode Island, the Department of Campus Recreation, the State of Rhode Island, the Rhode Island Department of Health, and the Center of Disease Control and Prevention.
  • I certify as the above named participant, I have reviewed all regulations listed in items #1-#5 above. I understand all of the terms and conditions of the above, hereby consent, and grant my permission to each and all of the foregoing.
  • By agreeing electronically, you acknowledge that you have both read and understood all text presented to you in this form.
  • YOUR SIGNATURE INDICATES COMPLIANCE WITH URI CAMPUS RECREATION ACKNOWLEDGEMENT OF PARTICIPATION INFORMATION, AUTHORIZATION AND RELEASE

  • Registration Polices

  • This URI Campus Rec program is a tuition for service program based on confirmed enrollment and secured deposit. Full registration payments must be received prior to the first day of Activity. All mandatory forms must be received by no later than the first day of each Activty.
  • Registration application will be accepted on a first come, first serve basis.All online registrations will have convenience fee added to the transaction. This amount is added on as a flat fee to your transaction total and goes directly to our registration service provider. The flat fee is only added one time to your total amount, even if you are paying for multiple sessions or campers at that time. If you register separately for each activty session, the convenience fee applies to each transaction.
  • If a medical condition arises, a letter for the doctor is required and will be evaluated by the Director of Campus Recreation on any partial credit if applicable. Each class will have a limited number of participant spaces available. I understand no refunds will be made. Returned checks or charges will be assessed a $25.00 fee.
  • Transfers:
    Transfers Class transfers must be made no later than one week prior to the scheduled start date; provided space availability by emailing the Coordinator of Sailing.
    Cancellations / Refund Policy:
    No refund will be provided for Sailing and Kayak Memberships, one week after day of purchase. All cancellations requests must be made by submitting a Campus Recreation Refund Request form for each participant. A $25 Administration fee will be accrued for each program cancellation if made at least two weeks prior to the program start date. A 30% administration fee will be accrued if cancellation is made within two weeks of the scheduled start date.
  • By agreeing electronically, you acknowledge that you have both read and understood all text presented to you in this form.