Student Involvement
www.involvement.rutgers.edu
Student Activities Center
osi@echo.rutgers.edu
Rutgers, The State University of New Jersey
613 George Street
848-932-6978
New Brunswick, NJ 08901
Fax: 732-932-1080
INFORMED CONSENT/TRAVEL WAIVER + LONGBOARDING
I,
(students name), will be participating in a
trip/event with the Rutgers Longboarding Club to
(place)
on
(date or date range) in_____________(name of city). I
understand and acknowledge the following:














That travel to and from the site via ______________________ (mode of transportation) entails
risks of bodily injury or property damage.
That participation is voluntary and it is at my own risk;
That participation is voluntary and at my own risk and is neither required nor is it part of any
course or curriculum requirement;
That by voluntarily providing transportation for other individuals to and from the site, I may
be liable for bodily injury or property damage assumed or incurred by these individuals.
That longboarding in an inherently dangerous sport which can result in severe physical
injuries and/or to the extent of a possible fatality;
That serious risks and hazards are associated with longboarding some of which include (but
are not limited to) variations in terrain (cracks in pavement, uneven gravel, puddles, ice dirt,
wet surfaces, etc.),surface, slippery areas;
That I have the sole responsibility of knowing my longboarding abilities and my abilities to
negotiate any path of terrain therefore I shall conduct myself within the limits of my own
abilities, and maintain control of my speed and course at all times;
That at all times I shall heed posted warnings and refrain from acting in a manner which
may cause or contribute to the injury of myself or others;
That I shall only utilize proper longboarding protection equipment;
That I am physically able to participate in the race or trip activities and I know of no
disability that would prevent my participation;
That while participating in longboarding activities at _________________________
(place), there are risks of bodily injury or property damage caused by or resulting from slips,
trips, or falls and other forms of physical harm.
That while in certain environments there is the unfortunate but real risk of being the victim
of a violent crime;
For any activity that I engage in, which is not scheduled by Rutgers, The State University of
New Jersey is not liable for any bodily injury, or property damage as a result of my
engagement in the said activity;
That in the event that a need for emergency medical services arises, I authorize and consent
to such service being provided and assume the cost thereof;




That while traveling I should carry appropriate copies of photo identification and health
insurance identification;
That I understand that alcohol is prohibited at Rutgers University trips/events. If I am found
in possession of alcohol during any part of this trip/event, including travel to and from the
site, I will be removed from Rutgers Longboarding Club and will face all judicial ramifications.
IF A DRIVER, that I have a valid Driver’s License and carry the legal limits of
automobile insurance. (Please attach copy of valid Driver’s License and
automobile insurance to this waiver.)
IF A DRIVER, that providing transportation for other individuals to and from the site, I may
be liable for bodily injury or property damage assumed by these individuals.
Notwithstanding these risks, I, for myself, my heirs and assigns do waive, release and discharge
Rutgers, The State University of New Jersey, its governors, trustees, officers, employees, and
agents from and against all claims , demands, actions, causes of actions, costs, and expenses for
and by reason of any personal injury, property damage, loss and expense, which heretofore have
been or hereafter may be sustained of suffered by my in consequence of and as a result of a certain
accident, casualty, or event or my presence or activities in connection with his Longboarding
trip/event. I also agree to indemnify and hold harmless Rutgers for injuries sustained either by me
and/or caused by me to others during this Longboarding trip/event. Furthermore, I acknowledge
that the risks outlines above are not intended to be all-inclusive and voluntarily accept all risks
known or unknown.
________________________
Participant’s Name (Print)
_____________________
Participant’s Signature
___________________
RUID
________________________
Emergency Contact’s Name
_____________________
Emergency Contact’s Phone Number
Date
I have the following health conditions and/or allergies that event coordinators should be aware of:
_________________________________________________________________________________
Health Insurance Carrier’s Name (Non-Rutgers guest only)
Policy Number (Non-Rutgers guest only)