CALIFORNIA STATE UNIVERSITY, FULLERTON

Assumption of Risk for Athletic Tryouts

													
   Print full name                         	Sport                               	  Date 

I have been informed and fully understand that California State University, Fullerton is not responsible in the event on an injury or illness incurred as a result of/or during an athletic tryout. I hereby waive all future claims against California State University, Fullerton and specifically the Department of Athletics, arising out of such an athletic tryout. I am aware that if medical care is necessary from said athletic tryout, it is try own responsibility for ANY financial charges incurred. 

I have been examined by a licensed medical doctor within the last year and I do not have any medical illnesses or injuries which will prohibit my participation in a tryout. I do not know nor do I believe there is any health reason why I should not participate in a tryout at this time. To the best of my knowledge, I am in good health and may participate without restrictions. I do understand that if I am selected to become a member of a California State University, Fullerton athletic team, I must undergo a complete physical examination administered by the CSUF Athletic Medicine staff. 

In the unlikely event that I might be unable to provide information for medical services and care, I wish it to be known that the name of my insurance company is 					 and my policy number is 							 

Mother / Father's name 								
		
Parents Address 											
			street         			city                   	state           zip 

Parents home phone 							 

Signature of student athlete 								

If under the age of 18, this form must be signed by a parent or legal guardian) 

Signature of parent  guardian