MEMBER RELEASE

SPORT CLUBS

I ______________________________________ voluntarily agree to participate in the WSU

________________________________ club.

In consideration of the opportunity to participate in these club activities I hereby agree to abide by the rules of the
Heskett Center and the reasonable directives of Heskett Center employees.

I attest and verify that I have full knowledge of the risks involved during club activities including but not limited to
practice, competition and travel. I recognize that participation in athletic activity carries with it certain inherent
dangers which are outside of the control of WSU or the Heskett Center and their employees.

I understand that WSU does not provide insurance for the sport clubs or their members. I understand that the
University recommends that each club member have current medical insurance coverage. I agree to waive any and
all claims, legal or damages which may result from my participation in athletic competition, except to the extent that
such claims may be brought under the Kansas Tort Claims Act (K.S.A. 75-6101, et seq.).

I further acknowledge that this waiver and release has been entered into knowingly and voluntarily and that my
signature hereon has not been obtained under duress or by coercion.

By signing this release I am also acknowledging that I will be responsible for any and all equipment that is checked
out to me prior to the first contest. At the end of the season it is my responsibility to return this equipment to the
coach or president. If I fail to return this equipment I will be subject to repayment with the Heskett Center. Failure to
return equipment will result in a hold being played on your grades or you Wichita State account.

Name _______________________________________Age_____Sex___________

Signature ___________________________________________________________

Parents Signature (required if under 18)___________________________________

Address___________________________________________Phone____________

City ____________________________State_________Zip____________________

Emergency Contact Person and Phone____________________________________

Insurance Company___________________________________________________

myWSUID ____________________________Date__________________________