Sports Medicine Essentials, 3e - 23

CHAPTER 2

|

Legal Considerations and Administration

RISK ACKNOWLEDGMENT
AND CONSENT TO PARTICIPATE
(Please Print Legibly)

Participant's Name: ______________________________________

Date of Birth: _______________________

Address: ___________________________________________________ Telephone:_____________________________
City: ________________________________________ State: _______________ Zip:_________________________
Parent/Guardian Name(s): _______________________________________________________________________
Address: ___________________________________________________ Telephone:_____________________________
City: ________________________________________ State: _______________ Zip:_________________________
A.

INFORMED CONSENT
The above named participant wishes to participate in the sport of:______________________________ in the
______________________________ sports program during the ___________ season. I realize that there are
risks involved in such participation, and I attended a meeting on _____________ where these risks were
discussed and explained. I watched the video entitled, _______________________, listened to presentations
by administrators, coaches and sports medicine experts, and had all my questions answered. I am aware playing
or practicing to play/participate in any sport can be a dangerous activity involving MANY RISKS OF INJURY.
understand that the dangers and risks of playing or practicing to play/participate in the above sport(s) include,
I but are not limited to death, serious neck and spinal injuries, which may result in complete or partial paralysis,
brain damage, serious injury to virtually all internal organs, serious injury to virtually all bones, joints, ligaments,
muscles, tendons, and other aspects of the muscular skeletal system, and serious injury or impairment to other
aspects of my body, general health and well-being. I understand that the dangers and risks of playing or practicing
to play/participate in the above sport(s) may result not only in serious injury, but in a serious and permanent
impairment of my future abilities to earn a living, to engage in other business, social and recreational activities,
and generally to enjoy life. I agree to accept these risks as a condition of participation in the above sport(s).

B.

AGREEMENT TO OBEY INSTRUCTION
Because of the dangers of participating in the above sport(s), I recognize the importance of following coaches'
instructions regarding playing techniques, training and other team rules, etc. I agree to obey all such instructions,
as well to comply with the recommendations of administrators, athletic trainers and doctors concerning injury
prevention and care.

C.

RELEASE AND ASSUMPTION OF RISK
In consideration of the _______________________________ Unified School District permitting me to try out
for the sports at ___________________________ High School and to engage in all activities related to the
team, including, but not limited to, trying out, practice or playing/participating in that sport, I hereby assume all
risks associated with participating and agree to hold the _____________________________ Unified School
District, its employees, agents, representatives, coaches, and all volunteers harmless from any and all liability,
actions, causes of actions, debts, claims, or demands of any kind and nature whatsoever which may arise by
or in connection with my participation in any activities related to the ____________________________ High
School team(s). The terms hereof shall serve as a release and assumption of risk for my heirs, estate, executor,
administrator, assignees, and for all members of my family.

D.

CONSENT TO PARTICIPATE
____________________________________________ __________________
Signature of Parent or Guardian
Date
____________________________________________ __________________
Signature of Parent or Guardian
Date
____________________________________________ __________________
Signature of Participant
Date

2-2 | Sample Risk Acknowledgment and Consent to Participate Form

23



Table of Contents for the Digital Edition of Sports Medicine Essentials, 3e

Contents
Sports Medicine Essentials, 3e - Cover1
Sports Medicine Essentials, 3e - Cover2
Sports Medicine Essentials, 3e - A
Sports Medicine Essentials, 3e - B
Sports Medicine Essentials, 3e - i
Sports Medicine Essentials, 3e - ii
Sports Medicine Essentials, 3e - iii
Sports Medicine Essentials, 3e - iv
Sports Medicine Essentials, 3e - Contents
Sports Medicine Essentials, 3e - vi
Sports Medicine Essentials, 3e - vii
Sports Medicine Essentials, 3e - viii
Sports Medicine Essentials, 3e - ix
Sports Medicine Essentials, 3e - x
Sports Medicine Essentials, 3e - xi
Sports Medicine Essentials, 3e - xii
Sports Medicine Essentials, 3e - xiii
Sports Medicine Essentials, 3e - xiv
Sports Medicine Essentials, 3e - xv
Sports Medicine Essentials, 3e - xvi
Sports Medicine Essentials, 3e - xvii
Sports Medicine Essentials, 3e - xviii
Sports Medicine Essentials, 3e - xix
Sports Medicine Essentials, 3e - xx
Sports Medicine Essentials, 3e - 1
Sports Medicine Essentials, 3e - 2
Sports Medicine Essentials, 3e - 3
Sports Medicine Essentials, 3e - 4
Sports Medicine Essentials, 3e - 5
Sports Medicine Essentials, 3e - 6
Sports Medicine Essentials, 3e - 7
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Sports Medicine Essentials, 3e - 61
Sports Medicine Essentials, 3e - Cover4
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