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Fill out this form to become a Golden Bear or update your registration.

Are you registering for the first time or renewing your registration?
Name
Address
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In case of emergency, relative or friend to contact:

In case of emergency, relative or friend to contact:

Medical Information

Medical Information

Personal Health, Assumption of the Risk and Release:

Personal Health, Assumption of the Risk and Release:

The undersigned acknowledges that physical exercise and use of facilities and services of the Golden Bears program of Shawnee State University constitutes strenuous activity which can cause physical injuries, illness, and ailments, including but not limited to heart attacks, strokes, high blood pressure, torn ligaments, muscle strains, and slipped discs. By engaging in such activities, the undersigned warrants that he/she is physically capable of participating in these activities and assumes all responsibility for and risk of health problems, injuries, or illnesses arising out of the use of the facilities and services of the Golden Bears program of Shawnee State University. The undersigned hereby assumes all responsibility for and risk of damage or injury that may occur to the undersigned as a participant of Shawnee State University’s Golden Bears program. In consideration of being accepted as a participate of said program, the undersigned hereby releases and discharged Shawnee State University, its employees, and agents from all claims, demands, rights, or causes of action, present or future, whether known, anticipated, or unanticipated, and resulting from or arising our of, or incident to, the undersigned’s engaging in said program.

Personal Health, Assumption of the Risk and Release:
The undersigned acknowledges that physical exercise and use of facilities and services of the Golden Bears program of Shawnee State University constitutes strenuous activity which can cause physical injuries, illness, and ailments, including but not limited to heart attacks, strokes, high blood pressure, torn ligaments, muscle strains, and slipped discs. By engaging in such activities, the undersigned warrants that he/she is physically capable of participating in these activities and assumes all responsibility for and risk of health problems, injuries, or illnesses arising out of the use of the facilities and services of the Golden Bears program of Shawnee State University. The undersigned hereby assumes all responsibility for and risk of damage or injury that may occur to the undersigned as a participant of Shawnee State University’s Golden Bears program. In consideration of being accepted as a participate of said program, the undersigned hereby releases and discharged Shawnee State University, its employees, and agents from all claims, demands, rights, or causes of action, present or future, whether known, anticipated, or unanticipated, and resulting from or arising our of, or incident to, the undersigned’s engaging in said program.