I fully realize that participation in intramural and University Recreation activities at Emporia State University is voluntary and involves certain risks that could result in injury. These injuries may range from a slight bruise or scratch to broken bones, internal injuries that could cause brain damage or paralysis, injuries to the spine that may cause quadriplegia and other types of catastrophic injuries that may even result in death. I know that the University does not provide any type of insurance for participants of intramural and University Recreation Programs activities, and I am aware of the student health insurance coverage plan available.

I, thereby, with the above understanding and knowledge, agree that I shall not hold the University Recreation Programs Department, the Division of Health, Physical Education and recreation, the State of Kansas, the Kansas Board of Regents, or Emporia State University and all administrators, agents and employees responsible or liable for any injury or damage incurred by me while participating in intramural or University Recreation Programs activities offered by Emporia State University or on Emporia State University facilities.

By entering your information onto this form I hereby acknowledge that I have read and agree to comply with all of the above.

Singles Name

Student I.D.

E-Mail Address

Phone Number

Doubles Name

Student I.D.

E-Mail Address

Phone Number

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Texas Hold'em Badminton Tournament Table Tennis Tournament