QUEST CLUBS

Quest Clubs program offers students the opportunity to participate and train in a competitive setting as a means to enhance and improve their collegiate experience and provide a vehicle for a well-rounded education through physical, social, and leadership development.

One of our goals is to improve the quality of life for students, members of the university community and where possible, the Squamish community at large by encouraging and supporting a physically-active lifestyle.


Quest offers the following Clubs:

  • Free Skiing
  • Ultimate
  • Mountain Biking
  • Cross Country Running
  • Cross Country Skiing
  • Climbing
  • Golf
  • Volleyball
  • Rugby
  • Sliding Center
  • Karate

Please print and return all completed forms to Acting Athletic Director, Fitness & Recreation Coordinator, Jean-Francois Plouffe.


Find the STUDENT ATHLETE CONSENT FORM here.


Please circle if you are currently CPR and/or First Aid certified:       CPR        First-Aid


NAME OF CLUB:________________________________________________


PERSONAL:

Name: ________________________________________________

Date of Birth: ________________________________________________

Address while studying at Quest: ________________________________________________

Home Address: ________________________________________________

Phone # at Quest: ________________________________________________

 

EMERGENCY CONTACTS:

Emergency Contact (must be related to you): _________________________________________________

Relation to you: ________________________________________________

Phone #: ________________________________________________

 

Emergency Contact #2: ________________________________________________

Relation to you: ________________________________________________

Phone #: ________________________________________________

 

MEDICAL INSURANCE INFORMATION:

Personal Health Number: ________________________________________________

Province of Issue: ________________________________________________

Extended | Private Health Insurance Provider: ________________________________________________

Policy Number: ________________________________________________

 

MEDICAL:

Are you currently taking any medication, vitamins, and/or supplements?

If not, write N/A:

If so, please specify:

 

Do you have any known allergies?

If not, write N/A:

If so, please specify:

 

CERTIFICATION: I certify that the information contained in this form is correct, truthful, and complete. I also certify that I have made a full and complete disclosure concerning my general health, specific injuries, allergies, medications, and head injury information.

 

CONSENT: I consent to the release of all information contained in, or arising from these documents to the appropriate members of the support staff of Quest University Canada and/or their designates for the purpose of treatment, rehabilitation, and insurance claim processing.

 

______________________________________

Athlete’s Signature

______________________________________

Date


INFORMED CONSENT AND ASSUMPTION OF RESPONSIBILITY, RISKS AND LIABILITY WAIVER:

BY SIGNING THIS LEGAL DOCUMENT, YOU WILL BE GIVING UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE – PLEASE READ CAREFULLY.

I________________________________________________, in consideration of the benefits derived from participation as an athlete on the________________________________________________club/team administratively organized by Quest University Canada, do hereby consent to participate in all varsity related activities under the following conditions:

□ I understand that games, practices, and activities take place on and off of the Quest University Canada campus. These will include, but are not limited to, practices, conditioning, meetings, games, and team building events;

□ I understand that I can ask questions about each activity, and can choose whether or not to participate in each activity. I understand that if I am injured, or feel otherwise that I am not in a capacity to participate safely, that I can opt out of participating for the period I deem necessary. I must communicate this to my coach.

□ I understand that coaching and facilitating may be done by our head coach, assistant coach, trainer, or other staff or volunteer organized by our coach to assist.

□ I understand the requirement, and confirm that I have valid comprehensive health insurance for the entire duration of my studies at Quest, and while outside Canada for any Quest-sponsored activities, including varsity athletics.

□ I understand that alcohol and drugs are prohibited during any practices, games, meetings, and trips.

□ I understand that GuardMe Health Insurance purchased through Quest for non-Canadian students in Canada and for team travel outside of Canada, does not cover any injuries sustained while under the influence of alcohol or drugs. I understand and agree that I am solely financially responsible for any medical expenses incurred that are not covered by health insurance.

□ I understand that I am responsible for arriving at all games and practices by the time indicated by my coach, and that a shuttle from Quest is provided. I understand that it is my coach’s decision about whether I must travel to and from games on the Quest shuttle.

ASSUMPTION OF RISKS and ASSUMPTION OF RESPONSIBILITY

□ I REALIZE THAT PARTICIPATION IN ATHLETIC ENDEAVOURS ENTAILS THE RISK OF INJURY TO ME. SUCH RISKS MAY INCLUDE, BUT ARE NOT RESTRICTED TO SLIPS; FALLS; PHYSICAL CONTACT WITH OTHER PEOPLE, EQUIPMENT, OR FACILITIES; ABNORMAL CLIMATIC CONDITIONS; AND ACCIDENTS DURING TRAVEL.

□ I freely and voluntarily accept and assume all such risks, dangers and hazards and the possibility of personal injury, death, violence, property damage or loss, during all the time of participation, resulting from activities, travel arrangements, and any other team-related activities.

□ I accept my responsibility to abide by the laws of the country, to ensure that I have adequate medical coverage, and obey all the rules set out for each team-related game or activity.

PLEASE CIRCLE AND INITIAL THE FOLLOWING QUESTIONS:

1. Do you read and understand English?

Yes

No

Initials: __________________

2. Do you understand the purpose of this waiver?

Yes

No

Initials: __________________

LIABILITY WAIVER AND INDEMNIFICATION:

In consideration of approval to participate on this team, I and any personal representative, hold harmless, release and forever discharge Quest University Canada, their coaches, directors, officers, faculty, staff, students, volunteers, agents, trainees, or employers from any and all actions, causes of actions, including negligence, claims and demands for damages, loss or injury, resulting from or arising out of my participation on this team. I also indemnify and save harmless Quest University Canada from any and all actions, causes of actions, demands, expenses or losses whatsoever which they may bear as a result of my participation in this event, by reason of damage to any and all property and any and all personal injuries, including death of others or myself.

By signing below I acknowledge that I have read and understand this document, and that all information provided is accurate and true. By signing this document, I authorize Quest University Canada to release information relating to emergency health or travel issues to my emergency contacts, and any Quest and/or medical staff deemed necessary. I also understand that this authorization will remain on file and serve as an ongoing authorization while I am participating on a varsity sports team with Quest University Canada. I also acknowledge that I may withdraw this authorization at any time by signed written letter providing an alternate emergency contact.

Name:

Date of Signing:

Signature:

Date of Birth:

Parent Name (if under 19 years of age):

Parent Signature (if under 19 years of age):


Optional: Additional Health Information

Please provide details of any health related conditions that we should be aware of that may affect you while you are a team member. Please include an outline of any treatment plan or medications that we should be aware of to help ensure your health and well-being.

 

Do you have a family physician that you wish us to contact in the case of an emergency? Are there any other health care providers that may have relevant information about your condition (s) that we should contact in an emergency?

 

PERSONAL:

Name: ________________________________________________

Date of Birth: ________________________________________________

Address while studying at Quest: ________________________________________________

Home Address: ________________________________________________

Phone # at Quest: ________________________________________________

 

EMERGENCY CONTACTS:

Emergency Contact (must be related to you): _________________________________________________

Relation to you: ________________________________________________

Phone #: ________________________________________________

 

Emergency Contact #2: ________________________________________________

Relation to you: ________________________________________________

Phone #: ________________________________________________

 

MEDICAL INSURANCE INFORMATION:

Personal Health Number: ________________________________________________

Province of Issue: ________________________________________________

Extended | Private Health Insurance Provider: ________________________________________________

Policy Number: ________________________________________________

 

MEDICAL:

Are you currently taking any medication, vitamins, and/or supplements?

If not, write N/A:

If so, please specify:

 

Do you have any known allergies?

If not, write N/A:

If so, please specify:

 

 

CERTIFICATION: I certify that the information contained in this form is correct, truthful, and complete. I also certify that I have made a full and complete disclosure concerning my general health, specific injuries, allergies, medications, and head injury information.

 

CONSENT: I consent to the release of all information contained in, or arising from these documents to the appropriate members of the support staff of Quest University Canada and/or their designates for the purpose of treatment, rehabilitation, and insurance claim processing.

 

______________________________________

Athlete’s Signature

______________________________________

Date