9.11-12.26 RUF Camping Trip

RUF Camping Trip
GROUP ACTIVITY ASSUMPTION OF RISK AND RELEASE AGREEMENT

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GROUP ACTIVITY ASSUMPTION OF RISK AND RELEASE AGREEMENT

Student Organization: Reformed University Fellowship

Trip: Camping Trip

Date(s): Friday, September 11 - Saturday, September 12, 2026

Trip Itinerary: Travel to and from Coldstream Christian Camp, 4730 Goodman Rd, Adams, TN), auto travel; bonfire/campfire; hiking; swimming; canoeing
1. I agree to this legally-binding Assumption of Risk and Release Agreement in consideration of being permitted by Belmont University to participate in the trip described above. If I do not sign this Agreement, I will not be permitted by the university to participate in the Trip and will assume all risks and responsibilities of any participation including all risk of loss of limb or life, property damage, or injury to others.
Please confirm your understanding of and agreement to the above statement.
Your First and Last Name

First NameLast Name
2. I understand that participation in the trip will include but not be limited to the following activities: Travel to and from Coldstream Christian Camp, 4730 Goodman Rd, Adams, TN), auto travel; bonfire/campfire; hiking; swimming; canoeing. I understand that the university does not require me to participate in this activity, but I want to do so, despite the possible dangers and risks involved.
Please confirm your understanding of and agreement to the above statement.
3. I recognize that there are risks and hazards directly or inherently involved, making these and related activities potentially dangerous. These include the risk of an automobile accident, drowning, Sprain, Strain, Fracture, Concussions, Contusions, Lacerations, Abnormal Blood Pressure, Heart Disorders, Fainting, Shortness of Breath, Chest Pains, Strokes, HeartAttack, Paralysis, Permanent disability, Death, Blindness, Deafness, Whiplash, Drowning, Debydration, Heat-related illness, Hypothermia, Nausea, Headache, Dizziness, Increase in pulse, Injury to eardrum, Spine injury, Ligament injury, Dislocation, Tendon injury, Meniscal injury, Cartilage damage, Blood clot, Emotional instability, Confusion, Delirium. With full knowledge of the facts and circumstances surrounding these activities, I voluntarily agree to assume all the risks and responsibilities of my participation in them, including all risk of loss of limb or life, property damage, or injury to others.
Please confirm your understanding of and agreement to the above statement.
4. I, on behalf of myself, my family, heirs and legal representatives release, waive, and forever discharge Belmont University, its agents, employees, officers, and governing board from and against any and all liability, claims and actions that may arise from injury or harm to me, from my death or from damage to my property in connection with this activity. I understand that this release covers liability, claims and actions caused entirely or in part by any acts or failures to act of Belmont University (or its governing board, employees or agents).
Please confirm your understanding of and agreement to the above statement.
5. I further grant permission for Belmont University, its agents or employees to obtain necessary medical attention in case of my sickness or injury. I consent to any necessary medical examination, diagnosis, or treatment and agree to be responsible for costs of such medical services. I understand that the University requires me to provide an emergency contact who is familiar with my medical history:
Emergency Contact First and Last Name
Relationship to Emergency Contact (i.e. parent, roommate, sibling, etc.)
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Although it is not a requirement, I may also include information the University could find helpful if aiding me in an emergency: (allergies, medications, etc.)
6. I agree that this Agreement is intended to be as broad and inclusive as permitted by the laws of the State of Tennessee, and that if any portion of this Agreement is held invalid, any such findings shall not affect the validity of the remaining provisions which shall remain in full force and effect.
Please confirm your understanding of and agreement to the above statement.
7. I have read this entire Agreement, I fully understand it and I agree to be legally bound by it. I warrant that I am over the age of 18. If I am 17 years old or younger, I understand that I must complete a physical form of this waiver and that my parent or guardian must sign the waiver before I will be permitted to participate in the Trip.
Today's Date

MonthDayYear
Date
Your BUID
Your Date of Birth

MonthDayYear
Date
If you are under the age of 18, we will need for you to complete the hard copy of this waiver and collect a parent signature as well, rather than the digital version. Your form will need to be submitted to the Office of Student Engagement before your group's deadline. (Email studentengagement@belmont.edu for more information)
Your Cellular Number
Please enter a valid phone number.Format: (000) 000-0000.
Student (Your) Signature
Should be Empty: