Page 1

Fields

First Name *
Last Name *
Email *
Home Phone *
Cell Phone *
Gender
Team Name *
Sport or Activity
Team Captain
League
Status
Comments
LSUS Informed Consent, Waiver and Release of Liability

In consideration of my involvement under the auspices of this sponsoring organization, I acknowledge and agree that:

  1. I have been directed to consult my physician prior to starting any weight loss, physical activity or exercise program.
  2. I risk bodily injury, including paralysis, dismemberment, and death, as well as loss of property;
  3. I knowingly and freely assume such risk;
  4. I, for myself, and on behalf of my heirs, assigns and next of kin, hereby release, holds harmless, and promise not to sue Louisiana State University in Shreveport, their officers, official agents, and/or employees, with respect to any and all such injury, paralysis, dismemberment, death, and/or loss of damage to property except that which is the result of gross negligence and/or willful or wanton conduct; and
  5. I wish to voluntarily participate in LSUS Recreational Sports.
Please check here if you accept these terms and conditions *