A Rugby Safety Checklist
by Dr. Dick Borkowski

Example Warning Form
Waiver and Release of Liability

DISCLAIMER: STATE UNIVERSITY IS NOT RESPONSIBLE FOR ANY INJURY (OR LOSS OF PROPERTY) TO ANY PERSON SUFFERED WHILE PLAYING, PRACTICING, OR IN ANY OTHER WAY INVOLVED IN THE RUGBY CLUB FOR ANY REASON WHATSOEVER, INCLUDING ORDINARY NEGLIGENCE ON THE PART OF STATE UNIVERSITY, ITS AGENTS, OR EMPLOYEES.

In consideration of my participation, I hereby release and covenant not to sue State University, State University Board of Trustees, The Sports Club Federation, The Rugby Club, and any of their employees, instructors, or agents, from any and all present and future claims resulting from ordinary negligence on the part of State University or others listed for property damage, personal injury, or wrongful death, arising as a result of my engaging in or receiving instruction in Rugby Club activities or any activities incidental thereto, wherever, whenever, or however the same may occur. I hereby voluntarily waive any and all claims resulting from ordinary negligence, both present and future, that may be made by me, my family, estate, heirs or assigns.

Further, I am aware that rugby is a vigorous team sport involving severe cardiovascular stress and violent physical contact. I understand that rugby involves certain risks, including but not limited to, death, serious neck and spinal injuries resulting in complete or partial paralysis, brain damage, and serious injury to virtually all bones, joints, muscles, and internal organs, and that equipment provided for my protection may be inadequate to prevent serious injury. I further understand that rugby involves a particularly high risk of knee, head, and neck injury. In addition, I understand that participation in the Rugby Club involves activities incidental thereto, including, but not limited to travel to and from the site of the activity, participation at sites that may be remote from available medical assistance, and the possible reckless conduct of other participants. I am voluntarily participating in this activity with knowledge of the danger involved and hereby agree to accept any and all inherent risks of property damage, personal injury, or death.

I further agree to indemnify and hold harmless State University and others listed for any and all claims arising as a result of my engaging in or receiving instruction in Rugby Club activities or any activities incidental thereto, wherever, whenever, or however the same may occur. I understand that this waiver is intended to be as broad and inclusive as permitted by the laws of [specify state] and agree that if any portion is held invalid, the remainder of the waiver will continue in full legal force and effect. I further agree that the venue for any legal proceeding shall be in [specify state].

I affirm that I am of legal age and am freely signing this agreement. I have read this form and fully understand that by signing this form, I am giving up legal rights and/or remedies which may be available to me for the ordinary negligence of State University or any of the parties listed above.

_______________________________________________________
(Signature of Participant) (Date)

_______________________________________________________
(Signature of Parent if Participant is Under 18) (Date)

(From: Cotten, Doyice J., "Before the Fall," Athletic Business Magazine, May 1996, p. 36)

to: A Rugby Safety Checklist

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