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Parent/Guardian or Emergency Contact Number 2
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MEDICAL INFORMATION: The Raleigh Rugby Club does not provide medical insurance
coverage for participants; each participant in RRFC Programs must rely on the private coverage of a comprehensive medical insurance policy. Your disclosure of this policy will allow us to quickly access this information in event of any medical emergency and our club safety measures.
Personal Medical Insurance Coverage(Required) Assumption of Risk, Waiver and Release of Liability for COVID-19/Coronavirus: The Carolinas Geographic Union, Capital Rugby Union, and North Carolina Youth Rugby Union require that every club associated with Raleigh Rugby Football Club has any person participating in their rugby activities, complete and return this document to their club before beginning participation.
The novel Coronavirus, COVID-19, has been declared by the World Health Organization to be a worldwide pandemic. COVID-19 is extremely contagious and is believed to spread mainly by person-to-person contact. Health officials also believe that a person may be infected with COVID-19 without his or her knowledge and that some people may remain asymptomatic.
I acknowledge that attending rugby related activities may increase the risk of infection and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I further understand that the risk of becoming exposed to or infected by COVID-19 at any rugby related activities may result from the actions, omissions or negligence of myself and others, including, but not limited to coaches, referees, trainers, volunteers, attendees or other participants.
I assume all risks of my or my child/ward’s participation in rugby activities, both known and unknown. I accept the sole responsibility for any injury or infection to myself, my child(ren)/ward, and my family, including but not limited to, personal injury, disability, death, illness, damage, or loss of any kind, that I, my family, or my child(ren)/ward may experience or incur in connection with my child(ren)/ward’s attendance and/or participation in any rugby activity.
On my behalf, and on behalf of myself, my child(ren)/ward and my family, I hereby release, discharge, waive, forever hold harmless, and covenant not to sue USA Rugby, Raleigh Rugby Football Club, Carolinas Geographic Union, Capital Rugby Union, and North Carolina Youth Rugby Union and all their employees, officers, volunteers, agents, and representatives thereof (collectively “Released Parties”) of and from all liability, claims, actions, damages, costs and expenses of any kind arising out of or relating to my or my child’s participation in rugby-related activities. I understand and agree that this release includes, but is not limited to, all claims based on the actions, omissions, or negligence of the Released Parties, whether a COVID-19 infection occurs before, during, or after participation in any rugby related activity or event.
I HAVE READ THE FOREGOING ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY AND I UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT.
CONSENT, LIABILITY & PHOTO RELEASE: With informed consent, I shall hold harmless the Raleigh Rugby Club, their sponsors, coaches, administrators, volunteers, officers, and owners of property on which Raleigh Rugby Club events occur for any loss or injury which might occur during participation in Raleigh Rugby Club sanctioned events. I also certify that the above-listed participant has been examined within the last year by a physician and has been determined fit to participate in rigorous athletic activities.
If the above-listed participant is in need of medical care, and my immediate consent is unavailable, I hereby give the Raleigh Rugby Club coaches and administrators present my consent to appropriate medical treatment. I assume full responsibility for the cost of any treatment given.
I give my consent to Raleigh Rugby to use the likeness of the above-listed participant in photographs and videos for marketing material and social media of Raleigh Rugby.
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