ROCK UNIVERSITYSUNDAY February 9th 2020
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ALL TRACK AND
FIELD ATHLETES WELCOME
Waiver on back must be completed and signed in order to
If you are under the age of 18, you must have a parent
or guardian sign.
If weather is
questionable call 724-421-5255
CHANGE IN REGISTRATION:
REGISTRATION: send email to firstname.lastname@example.org
with name of person competing and year of birth by midnight Wednesday before
the meet. The fee will be $15 per person.
Bring check with you on the day of the meet.
We do not need to know which events you will be doing.
REGISTRAION: show up on the day of the meet no later than 10:00am to register.
The cost for late registration will be $20.
Checks payable to "SRU Track and Field"
REGISTRATION: send email to email@example.com,
by midnight Wednesday before the meet he will provide registration instructions
and entry fee information.
Make Checks Payable to SRU
Track and Field
AWARDS: 1st, 2nd and 3rd for age groups younger than high school.
Field House, 200m Rubberized Track (No Spikes!!!!!)
SRU will provide starting
blocks, must provide your own shots
1 Morrow Way
Slippery Rock, Pa 16057
FIELD EVENTS: (Age groups may compete together)
10:00am Long Jump open pit - all jumpers
Triple Jump after long jump
Shot Put all males first
High Jump all females first
Pole Vault all females first
TRACK EVENTS: all track events are on a
rolling time schedule, girls followed by boys
Age groups may compete together
11:15am 55m hurdles
Call Bill Jordan for more meet
information 724-738-2797 or John Papa 724-738-2798
UNIVERSITY OF PENNSYLVANIA ASSUMPTION OF THE RISK AND LIABILITY RELEASE FORM
For the 2020 SRU Track and Field
PARTICIPANT NAME ________________________________________________
ACADEMIC YEAR______________ AGE_____________
PHONE #: _______________________
______________________, understand that that the risk of injuries is an
inevitable and inherent consequence of participating in the above-named event
to be held at Slippery Rock University and that no amount of reasonable
instruction and supervision, use of proper equipment or facilities will prevent
injuries. I realize, and understand,
that severe injuries are possible. I further understand and acknowledge that
any of these risks and others, not specifically named, may cause injury or
injuries that may be categorized as minor, serious, or catastrophic. Minor
injuries are common and include, but are not limited to: scrapes, bruises,
sprains, nausea, and cuts. Serious injuries are less common, but do sometimes
occur. They include, but are not limited to: property loss or damage, broken
bones, torn ligaments, concussions, exposure, heat-related illness, mental
stress or exhaustion, infection, and concussions. Catastrophic injuries are
rare, but can include permanent disabilities, spinal injuries and paralysis,
stroke, heart attack, and even death. I
have carefully considered how the possible consequences of such an injury may
impact my life, and despite this, I choose to assume this risk and to
participate in the above-named event. I
understand that Slippery Rock University is not responsible for personal
injuries or damages caused during my participation in this voluntary activity.
In accepting this risk, I expressly and
explicitly release and discharge from responsibility and liability Slippery
Rock University of Pennsylvania, the State System of Higher Education, the
Commonwealth of Pennsylvania, and the employees, officials or agents of any and
all of the foregoing, pursuant to, related to, or arising from, any injuries to
my person as a result of participating in the activity described above. In addition, I agree to indemnify and hold
harmless, legally and otherwise, Slippery Rock University of Pennsylvania, the
State System of Higher Education, the Commonwealth of Pennsylvania, and the
employees, officials or agents of any and all of the foregoing, pursuant to,
related to, or arising from, any injuries to my person as a result of
participating in the fitness and health testing.
I verify that I have
and acknowledge that Slippery Rock University and the State System of Higher
Education, the Commonwealth of Pennsylvania, and their employees, officials or
agents are not responsible for any health care expenses as a result of my
participation in fitness and health testing.
I verify that I have
no physical or mental disabilities, impairments or chemical dependencies that
might inhibit my participation in the activity described above and I agree to
abide by all Slippery Rock University regulations, directions and instructions
regarding my participation.
I understand that it is my responsibility to
inspect the course, facilities, equipment, and areas to be used, and if I
believe or become aware that any are unsafe or pose unreasonable risks, I agree
to immediately notify appropriate personnel. By participating in the event, I
am acknowledging that I have found the course, facilities, equipment, and areas
to be used to be safe and acceptable for participation. I accept full and sole
responsibility for the condition and adequacy of my equipment.
In case of injury while participating in the
above-named event, I hereby give advance permission to obtain medical services
on my behalf including, but not limited to, paramedic treatment, transportation
by emergency vehicle to a medical facility, and treatment by emergency
physicians. All extraordinary measures
are to be taken in regards to treatment and I shall assume all fiscal
responsibility as to any treatment and services. I will indemnify and hold harmless Slippery
Rock University of Pennsylvania, the State
System of Higher Education, the Commonwealth of Pennsylvania and their
employees, officials and agents from any and all financial and legal
obligations associated with emergency treatment, including all actions in
seeking and obtaining this service.
I UNDERSTAND FULLY THE INHERENT RISKS
INVOLVED IN THE ABOVE-NAMEDEVENT AND ASSERT
THAT I AM WILLINGLY AND VOLUNTARILY PARTICIPATING IN THE EVENT.
I have read the preceding paragraphs and
acknowledge that 1) I know the nature of the above-named event; 2) I understand
the demands of this activity relative to my physical condition; and 3) I
appreciate the potential impact of the types of injuries that may result from
the event. I HEREBY ASSERT THAT I KNOWINGLY ASSUME ALL OF THE INHERENT RISKS
OF THE ACTIVITY AND TAKE FULL RESPONSIBILITY FOR ANY AND ALL DAMAGES,
LIABILITIES, LOSSES, OR EXPENSES THAT I INCUR AS A RESULT OF PARTICIPATING IN
EMERGENCY CONTACT PERSON:
Phone Number _________________________________________________________________________________________________
I affirm that I have reached majority age (or will have reached that age by the
date of the above-named event. Majority age is 18 in all states except Alabama
(age 19), Nebraska (age 19), and Mississippi (age 21). I further affirm that I
am competent to sign this release. By
signing this release, I hereby acknowledge that I understand and voluntarily
accept the hazards, risks, rights and responsibilities noted in this release.
The terms of this release shall serve as a release and assumption of risk for
my heirs, estate, executor, administrator assignees, and all members of my
Participant ___________________________________________________ Date _________________
OR GUARDIAN'S RELEASE AND INDEMNIFICATION (Must be Completed for Minor
The undersigned, ("Parent(s)"), certify that
Parent(s) is/are the legal custodian(s) of _______________________ (print
minor's name - "Minor") and the Parent(s) and Minor have requested permission
from Slippery Rock University for Minor to participate in the above-named event
to be held at Slippery Rock University.
Parent(s) represent(s) that Parent(s) has/have read and understood the
preceding "Assumption of the Risk and Liability Release Form" to the end that
Parent(s) appreciate(s) the risks and hazards of the activity and agree(s) that
the terms and conditions of the Release Form will apply in connection with
Minor's participation in the above-named event.
Parent(s) release(s) any and all claims for any loss or damage sustained
by Parent(s) as a result of Minor's participation in the above-named event,
including claims for any medical expenses that Parent(s) may incur for
treatment for injuries sustained by Minor.
Parent(s) also agree(s) to indemnify and hold harmless Slippery Rock
University, the State System of Higher Education and the Commonwealth of
Pennsylvania from any and all claims for any loss, damage, injury, or expense
arising from or connected in any way with Minor's participation in the
above-named event that are brought by or on behalf of Minor or any other person
having or claiming to have a right of recovery in connection therewith. INTENDING
TO BE LEGALLY BOUND, Parent(s) has/have signed below.
SIGNATURE OF PARENT(S) _________________________________________________
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