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Sport Clubs

CWU Sport Club Individual Registration

The individual registration may take between 20-40 minutes to complete. This must be completed in one sitting, as this form cannot be saved and completed later. If you need to edit a previous page, click the "Previous" button on the bottom of this form. Do not click the "Back" button on your browser, or all of your information will be erased. To make the process move more quickly, please gather your health insurance, driver's license, and car insurance. If you are not a CWU student and plan to participate as an associate member, this is not the form for you. Please come to the Sport Clubs Office in the CWU Recreation Center. If you have any questions, please email the Sport Clubs Office at cwusportclubs@gmail.com.

MM/DD/YY (Must be 18 or older to participate)

High School/Previous College(s) Attended:

Contact Information:

xxx-xxx-xxxx

CENTRAL WASHINGTON UNIVERSITY SPORTS MEDICINE
ASSUMPTION OF RISK, WAIVER OF LIABILITY AND STATEMENT OF SHARED RESPONSIBILITY FOR SPORT SAFETY

 

I am aware that trying-out for, playing or practicing in any sport or recreational activity can be a dangerous activity involving many risks or injury. I understand that the dangers and risks of trying-out for, playing or practicing in the above sport(s) include, but are not limited to: death, serious neck and spinal injuries which may result in complete or partial paralysis or brain damage, serious injury to any and all bones, joints, ligaments, muscles, tendons and other aspects of my body, general health and well-being. I furthermore specifically acknowledge that participation in Central Washington University Recreation programs may involve a risk of injury and that participation in such requires an acceptance of risk of injury. I rightfully assume that those who are responsible for the conduct of sports have taken reasonable precautions to minimize such risk and that peers participating in the sport will not intentionally inflict injury upon others or me.

In consideration of Central Washington University permitting me to practice, play, try-out for or otherwise associate myself with the Central Washington University Recreation program, I, exercising my own free choice, voluntarily agree to participate in such activities, promising to take due care during such participation. I hereby acknowledge that I have been informed of the nature of the above named activities, including the risks of bodily injury, death or damage to property which may occur from known or unknown causes. I understand and hereby voluntarily accept and assume all risks associated with such participation and agree to discharge and release the state of Washington, the Washington State Board of Education, Central Washington University and their agents, servants and employees from any and all liability, claims, causes of action or demands of any kind and nature whatsoever which may arise by or in connection with my participation in any activities related to the Central Washington University Recreation program, so long as the conduct which caused the injuries or damages was not grossly negligent or willful and wanton. I will accept the personal and financial responsibility of such injuries and any expenses incurred for physician visits, exams, and diagnostic tests or otherwise that are related to

injuries suffered while participating in any try-out shall be my sole responsibility and not in any way the responsibility of Central Washington University or its agents, servants, or employees.
Because of the inherent dangers of participating in a contact or other type of sport, I recognize the importance of following the coach’s instructions regarding playing techniques, training rules of the sport and other team rules, and agree to obey such instructions.

I also understand that I MUST provide proof of comprehensive medical insurance in order to be allowed to participate in any try-out or take part in recreation athletics at Central Washington University. I also understand that I will be required to obtain the clearance of a physician, via a participation physical examination, to participate. I further understand that irrespective of the clearance of the team physician, I may be at greater risk of suffering injury, illness or death as a result of my participation. For the specific additional risks associated with my participation, I understand I should consult with my personal physician and specialist, in addition to the team physician. By continuing to participate in Central Washington University Recreation programs despite these additional risks, I agree to assume these additional risks and waive any claims I may have as set forth more fully in each of the above paragraphs.

I have had sufficient time to review and seek explanation of the provisions contained above, have carefully read them, understand them fully and agree to be bound by them. The terms hereof shall serve as a release and assumption of risk for my heirs, estate, executor, administrator, assignees and all members of my family.

 

Years of competitive experience in your sport:

Local Address:

Permanent Address:

CWU Photography & Sound Recording Release Form

I the undersigned hereby grant permission to Central Washington University (“CWU”), through its authorized representatives, to photograph or videotape me and, as applicable, to record my voice.  I further give CWU my permission to use such photographic and/or sound recordings, as well as my name, in any print and/or non-print media, including but not limited to CWU publications, broadcasting stations, and websites, for educational and/or promotional purposes.

I also authorize the limited commercial use by CWU of my photograph(s) in connection with my participation in CWU-sponsored events and activities, such as graduation ceremonies or sports activities.  Such commercial use shall be limited to offering my photograph(s) for sale to me and to my family, friends, and acquaintances.  However, I also authorize CWU for this purpose to make my photograph(s) available for purchase through commercially hosted photo-sharing web sites.

For all purposes authorized by me, I acknowledge and agree that I will not be compensated for any such uses, whether educational, promotional, or commercial.  I understand that CWU exclusively owns all photographic and/or sound recordings authorized by me.  I waive any right to inspect or approve such photographs or recordings, any version of them, or any printed or other media into which they may be incorporated for the uses authorized by me.  On behalf of myself, my heirs, assigns, and estate, I hereby release CWU and its authorized representatives from any claims arising from such uses, including any claims of defamation, invasion of privacy, or infringement of publicity rights.

This Agreement may be executed in counterparts, each of which shall be deemed to be an original and all of which together shall constitute one and the same instrument. Electronic transmission of any signed original document, and any retransmission of any signed electronic submission, shall be the same as delivery of an original.

Medical History

xxx-xxx-xxxx
xxx-xxx-xxxx

Alternate Emergency Contact Information:

xxx-xxx-xxxx
xxx-xxx-xxxx

Medical insurance is required to participate in the Collegiate Sport Club program. If you do not have medical insurance, you can find information about purchasing medical insurance provided by Central Washington University on the Sport Clubs website in the "Risk Management" section under "Handbooks and Forms." 

Primary Medical Insurance Information (Enter all that apply):

To compete in the Collegiate Sport Club program, it is strongly recommended that you complete a physical examination by a licensed physician.

Physician's Information (if not applicable, leave blank):

Check all that apply

Concussion Education

  • Concussions and other brain injures can be serious and potentially life threatening injuries. Research indicates that these injures can also have serious consequences later in life if not managed properly at the time of the initial incident.
  • A concussion occurs when there is a direct or indirect insult to the brain. As a result, impairment of mental functions such as memory, balance/equilibrium and vision may occur. It is important to recognize that many sport-related concussions do not result in a loss of consciousness. As a result, all suspected head injuries must be taken seriously.
  • Coaches and teammates are critical in identifying those student-athletes who may have a concussion because a concussed athlete may not be aware of their condition or may be trying to hide their injure to remain in practice or competition.

Here are the objectives for this Concussion Education component:

  1. Educate you about the potential negative effects of a concussion
  2. Provide you with some information to help you understand whether you or another club member may have suffered a concussion
  3. Identify some things you should or should not do if a concussion is suspected
  4. Provide a framework on when they should seek additional medical attention

The following questions are from a mobile device application that is available free of charge. The application is called the Concussion Quick Check App and is endorsed by international governing bodies including FIFA, the International Olympic Committee and several others.

You are encouraged to get this application and use it.

Concussions should be suspected in the presence of anyone or more of the following: symptoms (such as headaches), physical signs (such as unsteadiness), impaired brain function (e.g. confusion), or abnormal behavior.

Here are a list of questions that everyone should be able to answer correctly:

  1. What venue are we at today?
  2. What half is it now (if applicable)?
  3. Who scored last in this game?
  4. What team did you compete against last?
  5. Did your team win the last competition?

Here is a test that can be used to test an individual. This test is also a part of the Pocket SCAN2 application.

  1. Stand heel to toe with your non-dominant foot in back. Your weight should be evenly distributed across both feet.
  2. Try to maintain stability for 20 seconds with your hands on your hips and your eyes closed.
  3. I will count how many times you move out of this position.
  4. Open your eyes and return to the start position and continue balancing. I will start timing when you are set and have close your eyes.

Leadership Assessment

If you selected "Yes" for club officer, please answer the following six questions. If not, scroll to the bottom and click "Next"

Private Vehicle Waiver

I hereby certify that whenever I drive a privately owned vehicle on when traveling to or from a club event, I will have a valid driver’s license and proof of liability insurance in my possession:
1. All persons in the vehicle will wear a safety belt and the vehicle shall always be:
2. Covered by liability insurance for the minimum amount prescribed by State Law.
3. To the best of my knowledge, in safe mechanical condition as required by law.

*I further certify that, while using a privately owned vehicle on official when traveling to or from a club event, all accidents will be reported within 24 hours.
*I understand that permission to drive a privately owned vehicle on when traveling to or from a club event is a privilege which may be suspended or revoked at any time.

This Agreement may be executed in counterparts, each of which shall be deemed to be an original and all of which together shall constitute one and the same instrument. Electronic transmission of any signed original document, and any retransmission of any signed electronic submission, shall be the same as delivery of an original.

If you selected "Yes" for owning a vehicle, please answer the following four questions. If you selected "No", scroll to the bottom and click "Submit".

MM/DD/YY

Insurance Information. Answer all that apply.

Athlete Code of Conduct

The following information outlines the responsibilities of all CWU Sport Club participants. All students that participate in this program represent Central Washington University, Campus Recreation, and the Collegiate Sport Club program. When traveling to ANY event as a club, you are held to these standards from the time you depart campus to when you return. Anyone who breaches this code of conduct will be held accountable for their actions. Depending on the severity of the infraction, the student or club will face the University Recreation administration, as well as the CWU Student Conduct Council or campus police.