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Recreation Department
Skoglund and Tostrud Center
1520 St. Olaf Avenue
Northfield, MN 55057

Agreement for Assumption of Risk, Indemnification, Release, and Consent for Emergency Treatment for St. Olaf Community Members

"*" indicates required fields

Current membership fees for are listed below. The fees below are per person, based on each individual’s affiliation to the College. Dependents under age 18 must be added to the membership of their parent or guardian.

College Affiliation	1 year	6 month	3 month
Employee, Retiree, Emeritus	Free	Free	Free
Spouse or Committed Partner	$150	$100	$50
Alumnus	$150	$100	$50
Dependent Age 18-25	$150	$100	$50

Please select the type of St. Olaf community member you are*

Your identity and employment status will be verified by St. Olaf before you are allowed access to St. Olaf Recreation Facilities.

Which term membership would you like?*

Your Name*

I wish to use the St. Olaf College Athletic/Recreational Facilities.

First Last

Email*

Do not use a spouse or parent’s email address. Use your own.

Phone*

Birthdate*

YYYY

Graduation Year*

Affiliate Name

Person at St. Olaf (Employee, Alum, Emeritus, Retiree) to whom you are related

Your Spouse's Graduation Year*

Do you wish to include children in your membership?*

Only children up to age 17 may be included on this form. Children between the ages of 18-25 must complete their own “Agreement for Assumption of Risk, Identification, and Consent for Emergency Treatment for St. Olaf College”. Children who are 26 years or older are not permitted to apply a membership. This is inline with the age limits for dependents related to health insurance.

Yes

Number of Children*

I wish to include the following children on my membership (up to age 17) for an additional fee.*

$50 per child

Name of Child

Birthdate

Minor Policy*

I understand that children age 17 and under must be accompanied by a responsible adult while using the facility.

Guidelines:
I have read and agree to abide by the guidelines for the use of the Recreation facilities. I am medically fit to participate in the activities I will choose to engage in at the Recreation facilities. I understand that I may use the facilities only at times designated on the recreation program information sheet and that an adult member must accompany children under the age of 18 in the Recreation facilities at all times. I understand that priority is given to St. Olaf College students, faculty, and staff during open recreation hours. I understand that if I do not follow the policies and procedures of the Recreation facilities my recreation pass card may be revoked. St. Olaf has the option of closing areas for special events. I understand that this Assumption of Risk, Indemnification, Release and Consent for Emergency Treatment is intended to be as broad and inclusive as permitted by the laws of the state of Minnesota and I agree that if any portion is held invalid, the remainder will continue in full legal force and effect. I further agree that this Agreement shall be governed by the state of Minnesota.

I UNDERSTAND THAT I AM BEING ASKED TO READ EACH OF THE FOLLOWING PARAGRAPHS CAREFULLY. I UNDERSTAND THAT IF I WISH TO DISCUSS ANY OF THE TERMS CONTAINED IN THIS AGREEMENT, I MAY CONTACT THE VICE PRESIDENT/CFO, AT TELEPHONE NUMBER 507-786-3018.

Assumption of Risks:
I understand that physical activity related Recreation facilities use by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. Some of these involve strenuous exertions of strength using various muscle groups, some involve quick movement involving speed and change of direction, and others involve sustained physical activity, which places stress on the cardiovascular system. The specific risks vary from one activity to another, but in each activity the risks range from: 1) minor injuries such as scratches, bruises, and sprains to 2) major injuries such as fractures, internal injuries, joint or back injuries, heart attacks, and concussions to 3) catastrophic injuries including paralysis and death. I understand that the College has advised me to seek the advice of my physician before participating in this activity. I understand that I have been advised to have health and accident insurance in effect and that no such coverage is provided for me by the College. I KNOW, UNDERSTAND, AND APPRECIATE THE RISKS THAT ARE INHERENT IN THE ABOVE-LISTED PROGRAMS AND ACTIVITIES. I HEREBY ASSERT THAT MY PARTICIPATION AND THAT OF MY CHILDREN IS VOLUNTARY AND THAT I KNOWINGLY ASSUME ALL SUCH RISKS.

Assumption of Risks Agreement*

I agree to the terms of the “Assumptions of Risk” section above.

Hold Harmless, Indemnity and Release:
In consideration of permission for me to voluntarily use St. Olaf Recreation facilities today and on all future dates, I, for myself, my heirs, personal representatives or assigns, agree to defend, hold harmless, indemnify and release the Board of Regents of St. Olaf College and their officers, employees, agents, and volunteers, from and against any and all claims, demands, actions, or causes of action of any sort on account of damage to personal property, or personal injury, or death which may result from my participation in the above-listed program. This release includes claims based on the negligence of the Board of Regents of St. Olaf College, and their officers, employees, agents, and volunteers, but expressly does not include claims based on their intentional misconduct or gross negligence. I UNDERSTAND THAT BY AGREEING TO THIS CLAUSE I AM RELEASING CLAIMS AND GIVING UP SUBSTANTIAL RIGHTS, INCLUDING MY RIGHT TO SUE.

Hold Harmless, Indemnity, and Release Agreement*

I agree to the terms of the “Hold Harmless, Indemnity and Release” section above.

Consent for Emergency Treatment:
I authorize St. Olaf College and its designated representatives to consent, on my behalf, to any emergency medical/hospital care or treatment to be rendered that St. Olaf personnel deem necessary for my safety and protection as well as my children. I AGREE TO BE RESPONSIBLE FOR ALL NECESSARY CHARGES INCURRED BY ANY HOSPITALIZATION OR TREATMENT RENDERED PURSUANT TO THIS AUTHORIZATION.

Consent for Emergency Treatment*

I agree to the terms of the “Consent for Emergency Treatment” section above.

Non-Discrimination Statement:
St. Olaf College prohibits all forms of unlawful discrimination in any education program or activity that it operates. Individuals may report concerns or questions to the Director of Equal Opportunity. The notice of nondiscrimination is located at https://wp.stolaf.edu/nondiscrimination/

Do you have a valid St. Olaf ID or Community REC Card?*

If you have a previous photo REC card, please select “YES”. That card will be activated, and you will save $25

Yes

Do you have a current St. Olaf ID or STO Community REC Card?*

If you have a previous photo REC card, please select “YES”. That card will be activated, and you will save $25

Yes

Total Cost

Payment Information
Upon receipt of the signed waiver and paid fees, a Recreation ID card will be processed for you within 5 business days. This pass is for the exclusive use of the person named on the card. Those who have already obtained a Recreation ID card from the previous year will have their current card reactivated upon completion of signed waiver and payment. You will be required to scan your Recreation ID every time you enter the building.

You are required to pay before you are able to access the facilities. Only online payment will be accepted. After successfully submitting your form, you will receive an invoice via email to complete your payment within 3 business days.

Photo for ID Card*

Photo Requirements: Photo must be JPG and a ratio of 3/2 (height/width). i.e. Photo should be portrait orientation, rather than landscape orientation. Must be a color photo, taken in last 6 months Use a clear image of your face. No eyeglasses or face coverings. Use a plain white or off-white background.

Accepted file types: jpg, jpeg, Max. file size: 10 MB.

Signature*

I have read and understand this agreement. I certify that I am at least 18 years old. I understand that my use of the Recreational Facilities is voluntary. I verify that my signing of this agreement was freely and voluntarily given with the full understanding that I am giving up rights I may have to legal recourse and assuming personal responsibility that I may not otherwise have in return for permission to participate.

Comments

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