Register to be a Golden Bear

Must be 60 years of age and from Scioto County to register.




In case of emergency, relative or friend to contact:

List all medications you are taking at present time:

*Personal Health, Assumption of the Risk and Release (See below)

Read carefully the statement at the bottom of this page before signing.

I have read and understand and sign the foregoing assumption of risk agreement and release this:

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, stroke, high blood pressure, torn ligaments, muscle strains, and clipped 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 out of, or incident to, the undersigned’s engaging in said program.