Athlete Consent Form:

Transcription

1 Athlete Consent Form: Athlete Name: Prog Ref Code: P I hereby acknowledge that certain risks of injury are inherent to participation in recreational activities, sporting activities and lessons on and associated with the Strength & Conditioning Program. These types of injuries may be minor or serious and result from one s actions, or the actions or inactions of others or a combination of both. I hereby understand that certain activities require a minimum level of fitness and health (physical, mental, and emotional) and that each person has a different capacity for participating in these activities. Some activities involve an intense level of activity. I hereby agree that McMaster University, its faculty, staff and agents shall not be liable for any injury, loss or damage to person or property, incurred during this program, including deterioration of health or illness or aggravation of condition resulting from participation in these activities, property damage or lost property. I have read thoroughly the information brochure and understand the intensity of all activities involved. I understand that the level of my participation is based on my choice and that all McMaster University faculty, staff, and agents will respect my decision regarding the level of intensity of my participation. If at any time emergency medical treatment is necessary, I give my consent for treatment to be given. Every effort will be made to contact parent/guardian(s) and or emergency contacts. McMaster University may decline a participant due to physical and/or verbal abuse towards staff and participants. I hereby authorize McMaster University to take my photograph to display and otherwise use these photographs without charge solely for the purpose of promotional material in connection with Department of Athletics & Recreation Camps & Programs. I declare having read and understood the above informed consent agreement in its entirety. Signature of Athlete Witness Signature of Parent (if under the age of 18) Witness

2 Medical Screening Form: Due to the nature of activities associated with Strength and Conditioning Performance Services programs, all participants are required to provide accurate health and medical information prior to participation. All health information is maintained in the strictest confidence in accordance with required PEPIDA legislation. Athlete Information: Group Name: (s) of Program: _ of Birth: City: Phone # (Home): Address: Emergency : Contact Name: Relationship: Prog Ref Code: P Name of Participant: Home Address: Postal Code: Home Address: City: Postal Code: Phone # (Daytime): (Evening) Athlete Medication/Allergy Information: Please list any medications you are currently on, along with their purpose. (e.g. Diovan for High Blood Pressure, Celexa for Depression/Anxiety) Medication Purpose Please list any allergic reactions to medications, food or environmental factors: Allergy Reaction Treatment Epipen Required? Yes No Note: Please remember to bring your own Epipen(s) if required.

3 Medical Screening Form Continued: For most of the time, you will be undertaking activities which are best described as moderate exertion (normal walking, raking leaves, or waiting tables). Some situations may require you to momentarily engage in vigorous exertion (slow jogging, speed-walking, or fast biking). If these types of activities are difficult for you, we strongly advise you to discuss your participation in the course with a physician who knows your health history. If these are activities in which you regularly engage without difficulty, you should be fit for participation. Finally, there are a few specific medical conditions about which participants should always seek advice from their physicians before engaging in challenge course and climbing activities. Please consult with a physician prior to participation if you are pregnant, have had a kidney or liver transplant, are healing a fracture or joint injury, have had recent surgery, or have Down Syndrome. If you or your physician have any questions regarding these conditions or about the challenge course and climbing activities, feel free to contact us at ext I have reviewed this material, and have consulted with my physician if appropriate. I believe that I am fit to participate in the challenge course. I understand that I am not required to complete any event, and am free to modify my participation at any time. Athlete Name: _ Athlete Signature: : Authorization For Seeking Treatment of Minors: In the event of accident or apparent illness, I irrevocably authorize ALTITUDE staff to secure emergency medical services and treatment for this participant if, in their judgment, such services or treatments are necessary. I understand that in the event of a medical emergency every effort will be made to contact parents or guardians. Parent/Guardian: Signature: _ :

4 McMaster High Performance Laboratory Consent to Participate in Body Composition Testing Prior to participating please read and complete this from. The consent form outlines the purpose procedures and risks associated with the test and provides information regarding your rights and responsibilities as a participant. Description of body composition testing: A) BOD POD testing Body composition is an important determinant of health and athletic performance. The BOD POD system provides a fast and accurate determination of fat and fat-free mass by means of air-displacement plethysmography. The simple test consists of measuring a person s body mass, using a very accurate electronic scale, and body volume which is determined by sitting inside the BOD POD chamber. The BOD POD also provides information or resting metabolic rate and an estimate of a person s daily energy (calorie) requirement. B) Description of Potential Risks and Discomforts The potential risks and discomforts pertaining to the body composition testing relate tot feelings of claustrophobia while inside the BodPod chamber. Participants will be fully instructed on how to terminate the test at their own discretion to minimize these risks. C) Responsibilities of the Participant Information you possess about previous experience or anticipated feelings of claustrophobia should be fully disclosed. D) Provision of Confidentiality Any information that is obtained in connecting with the test procedures will remain confidential, and appropriate measures will be taken by all testing personnel to ensure privacy. The results from the test procedures may be used for education/scientific purposes (e.g., to develop normative test scores for the laboratory), however your personal data will remain confidential. Upon completion of the exercise test(s) you will have access to your own data. E) Participation and Withdrawal You can choose whether to take part in the body composition testing or not. If you consent to take part, you may withdraw at any time without consequences of any kind. Testing personnel also reserve the right to withdraw you from a test if circumstance arise which warrant doing so.

5 Signature of Participant and Legal Representative: I have read and understood the information described herein. My questions have been answered to my satisfaction and I agree to participate in the exercise test(s) described above Name of Participant Name of Parent/Guardian Signature of Participant Signature of Parent/Guardian Signature of Individual Conducting Test: In my judgment the participant (or Parent/Guardian) is voluntarily and knowingly giving informed consent and possesses the legal capability to give informed consent to participate in the exercise test(s). P Name of Trainer Signature of Person Conducting Exercise Test Testing Prog Ref Code Please adhere to the following conditions for the appraisal: Dress Requirements: Compression shorts and sports bra (women) or Speedo style swim suit must be worn. Food and Beverages: Do not eat for at least two hours prior to your appraisal Refrain from drinking caffeine beverages for two hours and alcoholic drinks for six hours prior to the appraisal Smoking: Do not smoke during the two hours prior to the appraisal. Physical Activity: Strenuous physical activity should be avoided for six hours prior to the appraisal. Please Note: Failing to adhere to the above conditions may negatively impact the testing results. If you are under the age of majority and living with a parent/guardian, your parent/guardian must sign this consent form as well.

6 Photo Release Form Photograph Owner: Office of Public Relations, McMaster University 1280 Main Street West, CNH 111, Hamilton, Ontario, Canada L8S 4L9 Photographer: I hereby assign and grant to McMaster University, or those to whom McMaster University grants permission, the right to copyright and use or publish and republish photographic images of me in which I may be included in whole or in part, in colour or in black and white, made through any media, including the use of any printed or electronic matter in conjunction with such photographs. I hereby waive my right to inspect or approve the finished photograph or copy of the material that may include such photographs or the eventual use to which it might be applied. I hereby release and discharge McMaster University and all persons acting under its authority or permission and those for whom it is acting, from and against any liability as a result of any distortion, blurring, alteration or optical illusion that may occur in the taking of the picture or processor or reproduction of the finished product. I hereby warrant that I have reached 18 years of age and I am competent to sign contract in my own name. I have read the above release and I fully understand its contents. Signature of Participant and Legal Representative: I have read and understood the information described herein. Name of Participant Name of Parent/Guardian Signature of Participant Signature of Parent/Guardian