University of Iowa Field Hockey - 2023 Hawkeye Spring Clinic - Session 2

Event Date(s):
Saturday, April 22, 2023 8:30AM - 10:30AM
Grant Field

Event Options: *

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Enter any medical/dietary conditions or special instructions/needs you may have or 'None'
Waiver of Liability


Release of Liability

In consideration for my child being permitted to participate in The University of Iowa Sports Camps Program, on behalf of my child, myself, our family, our heirs, and assigns, I hereby release the Board of Regents, State of Iowa; The University of Iowa Sports Camps Program; State of Iowa; and The University of Iowa, and each of their respective employees, agents and representatives from any and all liability for personal injury, including death, or property damage or loss suffered by my child as a result of, arising out of, or in any way involving participation in this Program, except to the extent that such liability results directly from the negligence of the University of Iowa, its agents or employees.

I acknowledge that I know, understand, and appreciate the inherent risks associated with my child’s participation in Program activities. These risks may include but are not limited to; scrapes, sprains, strains, contact with other participants, head injury, neck injury, paralysis, or other bodily injuries; or death; and damage to or loss of personal property. The risks include exacerbation of pre-existing medical conditions. I fully assume the inherent risks associated with my child attending this Program and assert that my child has chosen to participate in this Program, with my express approval.

Media Release

I grant the University of Iowa and persons acting for or through them the right to use, reproduce, assign, and/or distribute images, audio and video recordings, and likenesses in any medium whatsoever, of my minor children, identified above, for whom I have custody, for the purpose of promoting the University of Iowa, any of its Programs or Centers, or for any other lawful purpose, without payment to me. The University, its successors and assigns shall own all right, title and interest, including the copyright, to any such image, recording, or likeness.

I hereby release and hold harmless the Board of Regents, State of Iowa; the University of Iowa Sports Camp Program, the University of Iowa and the State of Iowa; as well as each of their respective agents and employees from any and all claims, including but not limited to claims of infringement, damages or remuneration, for invasion of privacy, defamation, or misappropriation, or otherwise arising from such use.

Emergency Consent and Agreement to Assume Costs Related to Treatment

In the event my child requires medical care while attending the Program, all reasonable attempts will be made to contact me at the phone numbers provided to obtain consent for treatment. In the event you are unable to reach me, emergency treatment may be provided as needed. If in the judgement of the heath care provider the medical care is not an emergency, no treatment will be provided until my consent has been provided by phone or in person.

I agree to assume all costs related to such treatment and authorize my insurance company to pay benefits to the University of Iowa Student Health Service, the University of Iowa Hospitals and Clinics, or UI QuickCare. Also, I authorize the disclosure of medical information to my insurance company for the purposes of this claim. (Each camper must provide his/her own health insurance.)

I am submitting a registration for my child to participate. By checking this box and submitting this registration form I certify that: I am the parent/legal guardian of the participant named on this registration form; I understand and accept the risks associated with my child's participation; I understand and agree to all terms of the above.