Drexel University Sport Club Membership Release Form

Today's date:	July 5, 2008
Team:	Drexel Kinokawa Aikido Club
Student Name: *
Email Address: *
ID No.: *
Gender:	Male      Female
Status:	FR    SO    PRE-JR    JR    SR  Grad    Faculty    Staff
Campus Address:
Home Address:
Home Phone:
Campus Phone:
EMERGENCY CONTACT:
Name: *
Address: *
Phone: *
* REQUIRED FIELDS!!

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I desire to participate in the DREXEL UNIVERSITY SPORTS CLUB PROGRAM. I am aware that the Program operates with volunteer coaches, some of whom may even be students, team members, or former team members; that the athletes and participants in Sports Clubs do not have access to training, consultation or treatment at the Drexel University Athletic Medicine Office; that said participants and athletes are not covered by the provision of the institution's intercollegiate athletic insurance policy; and that the athletes and participants may travel to events in athlete or coach-driven state owned on private vehicles.

In consideration of the institution providing some administrative support recognizing the team as representing student, staff and faculty of DREXEL UNIVERSITY and in permitting me to participate on the Aikido team, I hereby release DREXEL UNIVERSITY, and their respective officers, employees, agents or representatives from any and all liability, claim, costs, expenses, injuries or losses resulting from negligence of the attributable in whole or in part to my traveling to, training for, being coached in, using equipment for or participating in the above mentioned sport in the institution's Sport Club Program.

Recognizing every activity has a certain degree of risk, some more than others, I knowingly and voluntarily assume the risk of those injuries, regardless of severity, which from time to tome normally occur as a result of participation in the above mentioned sport.

I, the undersigned, am at least 18 years of age and have read this release and understand all its terms.

*IT IS STRONGLY RECOMMENDED THAT EACH PARTICIPANT IN THIS PROGRAM PURCHASE INSURANCE WHICH COVERS ACCIDENTS WHICH MAY OCCUR DURING PARTICIPATION IN CLUB SPECIFIC ACTIVITIES.