ID
(e.g. 123456789) not required
First Name
Last Name
Description
Plan
I am aware and appreciate that there are risks of injury
involved in my participation in the strength and
conditioning program at the University of Wisconsin
at La Crosse.
By submitting this form it is intended to make me aware
of my responsibilities in preventing potential injuries
or harm, reporting actual injuries, and complying with
the treatment plan of my health care providers and
indicates that I understand and appreciate the risks
involved with my participation. I understand
that this includes the risk of brain and spinal cord
injury that may result in paralysis, other permanent
injury, or possibly death.
I further, hereby certify that I am physically fit to
participate in the strength and conditioning programs
offered in the UW-L Strength and Conditioning Center.
I do hereby agree to hold harmless and indemnify the
State of Wisconsin, the Board of Regents of the
University of Wisconsin System, and the University of
Wisconsin-La Crosse, their officers, agents and
employees, from any and all liability, loss, damages,
costs, or expenses which are sustained or incurred by
me, and which may include damage to my personal
property, personal injury or death, arising out of my
actions in the course of participation.
