Non-Team Member Athletic Facility Usage Agreement

Name of Individual Using Athletic Facilities*

Preferred email address*

Preferred phone number*

Sport:*

Are you currently enrolled at UGA?*

Yes
No

** Either returning to complete undergraduate degree or enrolled in a graduate program

Years of attendance at UGA as a student-athlete*

** Enrollment year - graduation or final year as a SA (e.g. Fall 2010 - Spring 2014)

Do you have athletics eligibility remaining?*

Yes
No

Are you currently employed at UGA?*

Yes
No

** If yes, please provide the Department and Supervisor's Name using the explanation box below.

In what city, state, and country do you currently reside?*

Where are you staying while in Athens? If lodging with an individual or family, please explain the relationship*

How often do you plan on using UGA athletic facilities?*

One day
One week
Regular basis during fall semester
Regular basis during winter break
Regular basis during spring semester
Regular basis during summer

** Please explain your intended use in the box below

Explanation*

Did a UGA coach invite you to workout or practice with the team or specific student-athletes?*

Yes
No

** If yes, please explain below

Explanation

Are you currently affiliated with a professional team or compete professionally as an individual?*

Yes
No

** This includes employment in any capacity (player, coach, front office personnel, etc.)

Explanation

Are you currently represented or employed by an athlete agent, athlete financial advisor, disability insurance provider, or athlete marketing agency?*

Yes
No

** Include the name, company, and services provided by the representative in the box below.

Explanation

Are you related to, or have a close relationship with, any prospective student-athletes?*

Yes
No

** If yes, please explain below

Explanation

Please list all guests who will accompany you to campus at any point during your use of UGA athletic facilities (e.g. personal trainer, friends, family, etc.)*

Do you train athletes in any capacity?*

Yes
No

** Strength, conditioning, mechanics, mental, etc.

Explanation

Will you be using UGA athletic facilities to provide instruction to high school aged kids?*

Yes
No

** If yes, please explain below.

Explanation

By checking the box below, you agree to abide by the corresponding regulations:*

I will not provide benefits of any kind to current student-athletes;

I will not provide benefits of any kind to prospective student-athletes;

I will follow all facility rules, hours, and usage guidelines

** "Benefits" include meals, lodging, transportation, clothing, training expenses, loans, etc.

I have read and agree to the statement below*

I certify that the information I have provided is true and accurate. Further, I understand that failure to provide truthful responses could result in violations of NCAA, SEC, and/or UGAA rules and regulations. Violations of this nature may result in loss of eligibility for current student-athletes and/or prospective student-athletes, penalties imposed upon the University of Georgia, and/or your disassociation from the University of Georgia.

UGAAA Acknowledgement, Release, Waiver of Liability, and Covenant Not to Sue

Guidelines Regarding Treatment, Care, and Facility Access to Non-Team Member Athletes can be viewed in its entirety here or downloaded below at the bottom of the page.

In consideration for my use of the University of Georgia athletic facilities and equipment including, but not limited to, strength and conditioning facilities and equipment, athletic training facilities and equipment, athletic fields, athletic courts, running track, and swimming and hydrotherapy pools, I hereby agree to release, waive, discharge, and covenant not to sue the University of Georgia, the Board of Regents of the University System of Georgia, the University of Georgia Athletic Association, Inc., their members individually, and their officers, agents, and employees from any and all claims, demands, rights, and causes of action of whatever kind, arising from or by reason of any personal injury or property damage, or the consequences thereof, including death, resulting from or in any way connected with my voluntary choice to use the athletic facilities and equipment. I understand that use of the athletic facilities and equipment may expose me to the risk of property damage and bodily or personal injury including, but not limited to, broken bones, sprains, strains, concussions, and possibly death, as well as other risks that may not be foreseeable. To the best of my knowledge, I am in good physical condition and am not aware of any physical infirmity which would place me at risk in using these facilities and equipment or in receiving treatment. I acknowledge and assume any and all such risks to my personal health should I use the athletic facilities and their equipment with or without supervision at any time. I agree to at all times follow all rules and regulations of the facilities as well as the directions of the University of Georgia athletic staff and strength and conditioning staff including, but not limited to, the Policy Regarding Treatment, Care, and Facility Access to Non-Team Member Athletes. I agree to leave the facilities if asked to do so by a member of the staff. I understand that failure to adhere to the policies of the University of Georgia, the University of Georgia Athletic Association, Inc., and the Board of Regents of the University System of Georgia may result in my barment from the facilities. I acknowledge that accident/medical insurance is not provided to me by the Board of Regents of the University System of Georgia, the University of Georgia, or the University of Georgia Athletic Association, Inc. If injured while at University of Georgia athletic facilities, I understand that I am responsible for my own medical expenses and/or insurance coverage. I further covenant and agree that for the consideration stated above I will not sue the University of Georgia, the Board of Regents of the University System of Georgia, the University of Georgia Athletic Association, Inc., its members individually, its officers, agents, or employees for any claim for damages arising out of my voluntary choice to use the athletic facilities or equipment. It is my express intent that this Acknowledgement, Release, Waiver of Liability, and Covenant Not to Sue shall bind the members of my family and spouse along with any heirs, assigns, and personal representatives. I further agree that this Acknowledgement, Release, Waiver of Liability, and Covenant Not to Sue shall be construed in accordance with the laws of the State of Georgia. I understand that the acceptance of this Acknowledgement, Release, Waiver of Liability, and Covenant Not to Sue by the University of Georgia and the Board of Regents of the University System of Georgia shall not constitute a waiver, in whole or in part, of sovereign immunity by the University, the Board, or their respective members, officers, agents, and employees.*

I have read and fully understand the contents of the Guidelines Regarding Treatment, Care, and Facility Access to Non-Team Member Athletes and of this Acknowledgement, Release, Waiver of Liability, and Covenant Not to Sue and execute it as my own voluntary act indicating my agreement with all of its terms. In signing this Acknowledgement, Release, Waiver of Liability, and Covenant Not to Sue below, I acknowledge and represent that I have read and understand it and sign it voluntarily; I am at least eighteen (18) years of age and fully competent; and I execute this Release for full, adequate and complete consideration fully intending to be bound by the same.

In consideration for my use of the University of Georgia athletic facilities and equipment including, but not limited to, strength and conditioning facilities and equipment, athletic training facilities and equipment, athletic fields, athletic courts, running track, and swimming and hydrotherapy pools, I hereby agree to release, waive, discharge, and covenant not to sue the University of Georgia, the Board of Regents of the University System of Georgia, the University of Georgia Athletic Association, Inc., their members individually, and their officers, agents, and employees from any and all claims, demands, rights, and causes of action of whatever kind, arising from or by reason of any personal injury or property damage, or the consequences thereof, including death, resulting from or in any way connected with my voluntary choice to use the athletic facilities and equipment.

I understand that use of the athletic facilities and equipment may expose me to the risk of property damage and bodily or personal injury including, but not limited to, broken bones, sprains, strains, concussions, and possibly death, as well as other risks that may not be foreseeable. To the best of my knowledge, I am in good physical condition and am not aware of any physical infirmity which would place me at risk in using these facilities and equipment or in receiving treatment. I acknowledge and assume any and all such risks to my personal health should I use the athletic facilities and their equipment with or without supervision at any time.

I agree to at all times follow all rules and regulations of the facilities as well as the directions of the University of Georgia athletic staff and strength and conditioning staff including, but not limited to, the Policy Regarding Treatment, Care, and Facility Access to Non-Team Member Athletes. I agree to leave the facilities if asked to do so by a member of the staff. I understand that failure to adhere to the policies of the University of Georgia, the University of Georgia Athletic Association, Inc., and the Board of Regents of the University System of Georgia may result in my barment from the facilities.

I acknowledge that accident/medical insurance is not provided to me by the Board of Regents of the University System of Georgia, the University of Georgia, or the University of Georgia Athletic Association, Inc. If injured while at University of Georgia athletic facilities, I understand that I am responsible for my own medical expenses and/or insurance coverage.
I further covenant and agree that for the consideration stated above I will not sue the University of Georgia, the Board of Regents of the University System of Georgia, the University of Georgia Athletic Association, Inc., its members individually, its officers, agents, or employees for any claim for damages arising out of my voluntary choice to use the athletic facilities or equipment. It is my express intent that this Acknowledgement, Release, Waiver of Liability, and Covenant Not to Sue shall bind the members of my family and spouse along with any heirs, assigns, and personal representatives. I further agree that this Acknowledgement, Release, Waiver of Liability, and Covenant Not to Sue shall be construed in accordance with the laws of the State of Georgia.

I understand that the acceptance of this Acknowledgement, Release, Waiver of Liability, and Covenant Not to Sue by the University of Georgia and the Board of Regents of the University System of Georgia shall not constitute a waiver, in whole or in part, of sovereign immunity by the University, the Board, or their respective members, officers, agents, and employees.

Signature*

UGAAA Acknowledgement, Release, Waiver of Liability, and Covenant Not to Sue

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