Step 1 of 4

Fill in Application

Step 2 of 4

Confirm Information

 

Step 3 of 4

Payment Options

 

Step 4 of 4

Download & Print PDF

 

Interscholastic Equestrian Association - It's your future. Take the reins. Grades 6 - 12.

ADULT CONTRIBUTING MEMBER APPLICATION
And
Inherently Dangerous Activity Acknowledgement
Waiver of Liability Form
2014-2015

*required fields

Inherently Dangerous Activity Acknowledgement Waiver of Liability:

For purposes of this Application and Waiver, the "IEA Group" is defined as the Interscholastic Equestrian Association, Inc. ["IEA"], the stables, owners, persons or other entities providing facilities, horses or equipment for any IEA affiliated, sanctioned or sponsored show or event, the IEA Host Team, IEA Host Sponsor, the Event Host Coordinator, the facility, the location and owner, manager, operator, lessor and lessee of the facility where any IEA affiliated, sanctioned or sponsored show or event is held, IEA Members, IEA Coaches, IEA Teams, all educational institutions sponsoring or lending their name to an IEA Team or IEA event, all other competitors, participants, spectators, exhibitors and riders in or at an IEA event or show, all other persons directly or indirectly associated with IEA, and their respective executors, administrators, agents, officers, directors, staff, employees, trustees, members, shareholders, owners, representatives, heirs, successors and assigns of each of the above named persons and entities.

Also, for purposes of this Application and Waiver the "undersigned persons" are defined as the rider, the parents or legal guardians of the rider, the coaches, the contributing members, and all other IEA Members, and their respective executors, administrators, attorneys, agents, representatives, heirs, and assigns.

The undersigned persons fully and unconditionally agree to hold the IEA Group harmless from any injury, harm or even death resulting from all inherent risks and intrinsic dangers of horseback riding or being around horses in general. The undersigned persons further attest and swear that they were carefully and explicitly educated and informed on the unpredictable behavior of horses and dangerous nature of horseback riding and being in close contact with horses in general.

The undersigned persons attest and swear that they are fully aware that there exist valid and enforceable equine activity limiting liability statutes in most, but not all, states where IEA competes ["Laws"]. These Laws limit the liability for those who provide access to horses and horse related activities. Each of those Laws is incorporated herein by reference. In the event that no such Laws exist, the undersigned person(s) have been informed of a legal doctrine known as "assumption of the risk", which means that a person involved or participating in a dangerous activity (and his/her parent or guardian) fully agree to take full responsibility for any injury, harm, or even death resulting from a danger or risk that is normal, reasonably anticipated, natural, built-in, intrinsic to or inherent to the chosen equine activity. The undersigned persons agree and knowingly assume all risks associated with IEA events, shows, training, travel, and related activities ["IEA Events"].

The undersigned person(s) fully and completely understand and comprehend that were it not for their full agreement to hold the IEA Group harmless for injuries, harm, or even death resulting from the inherent risks and intrinsic dangers associated with the IEA Events, the IEA Group would not provide these services, shows and events and IEA would not sanction or sponsor competitions.

The undersigned persons acknowledge that they have been informed of the skill level and IEA rider placement level assigned to the participating rider. By signing the IEA Application form, the undersigned persons agree to and approve of the skill level and IEA rider placement level assigned to the participating rider.

The undersigned persons fully and unconditionally agree to assume all inherent risks and intrinsic dangers associated with IEA Events, including, but not limited to, the following:

  1. The propensity of a horse to behave in ways that may result in injury, harm or death to persons on or around the horses. The powerful and potentially dangerous and destructive ways in which these large animals can behave include, but are not limited to, bucking, shying, kicking, running, biting, stumbling, rearing, falling and stepping on any person on or near the horse;
  2. The unpredictability of the animal's reaction to such things as sounds, sudden movement, and unfamiliar objects, persons, or other animals;
  3. The unpredictable or erratic actions by other horses or persons relating to equine behavior;
  4. Certain hazards such as arena and training surfaces and subsurface conditions;
  5. Collisions with other animals, fences, gates, barriers, objects, or persons;
  6. The potential for the rider participants and others at IEA Events to act in a negligent manner that may contribute to injury to the rider or others, such as failing to maintain control over the animal or not acting within his or her riding ability; and
  7. Other unforeseeable or unpreventable accidents or events associated with or a result of horseback riding or being around horses in general.

Important Notice Regarding Waiver of Claims for Negligence: The undersigned persons fully attest and swear that they sought and received (independent of anyone associated with the IEA Group) information and education about the legal concept of negligence (normal carelessness). The undersigned persons fully agree and consent to waive all claims, actions, causes of actions, and liability for all damages and injuries of any kind, whether having occurred in the past or in the future, stemming from any ordinary act of negligence (including failure to warn) on the part of the IEA Group. This waiver shall extend to claims for negligence stemming from any cause whatsoever including injuries or death that occurs during horse riding AND non-horse riding activities, including, but not limited to injuries or death that occurs while participants are leading or riding a horse, are around horses, while participants are receiving instruction on riding skills, or are under the supervision of riding instructors or IEA Coaches.

By making application for membership to IEA, each member, parent and legal guardian certifies he/she has thoroughly read and understands the IEA Rules and Regulations, authorizes IEA to distribute the member's name, address, email address, gender, and other available demographic information to IEA sponsors, advertisers and other equestrian related companies, activities, programs, and organizations, and authorizes IEA, its sponsors and publicists to use for promotional purposes all photographs, videos, or digital images taken at any IEA show or event.

LEGAL NOTICE: The undersigned persons agree that the terms and conditions of this waiver, any dispute as to the enforcement of this waiver agreement, and all claims or lawsuits filed by or against IEA, or any or all IEA Group members, shall be interpreted according to and under the laws of the State of Ohio. Any claim or litigation regarding the enforcement or interpretation of this waiver agreement, and all claims or lawsuits filed by or against IEA, or any or all IEA Group members, shall exclusively be brought and filed in either state or federal court in Columbus, Ohio.

WARNING: Under Alabama law an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to the Equine Activities Liability Protection Act.

WARNING: Under Arizona Law an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities resulting from ordinary negligence or the inherent risks of equine activities.

WARNING: Under Arkansas Law an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risk of equine activities.

WARNING: Under Colorado Law an equine professional is not liable for injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to section 13-21-119, Colorado Revised Statutes.

WARNING: Under Connecticut Law participants assume the risk and legal responsibility for any injury arising out of the hazards inherent in equestrian sports.

WARNING Under Delaware Law an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to Delaware Code Title 10, Section 8140.

WARNING: Under Florida Law an equine sponsor or equine professional is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities."

WARNING: Under Georgia law an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of the equine activities, pursuant to Chapter 12 of Title 4 of the Official Code of Georgia Annotated.

WARNING Under the Equine Activity Liability Act of Illinois each participant who engages in an equine activity expressly assumes the risks of engaging in and legal responsibility for injury, loss, or damage to person or property resulting from the risk of equine activities.

WARNING: Under Indiana Law an equine professional is not liable for injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities."

WARNING Under Kansas law there is no liability for an injury to or the death of a participant in domestic animal activities resulting from the inherent risks of domestic animal activities, pursuant to K.S.A. 60-4001 through 60-4004. You are assuming the risk of participating in this domestic animal activity. Inherent risks of domestic animal activities include, but shall not be limited to: (1) The propensity of a domestic animal to behave in ways i.e., running, bucking, biting, kicking, shying, stumbling, rearing, falling or stepping on, that may result in an injury, harm or death to persons on or around them; (2) the unpredictability of a domestic animal's reaction to such things as sounds, sudden movement and unfamiliar objects, persons or other animals; (3) certain hazards such as surface and subsurface conditions; (4) collisions with other domestic animals or objects; and (5) the potential of a participant to act in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the domestic animal or not acting within such participant's ability.

WARNING: Under Kentucky Law a farm activity sponsor, farm animal professional or other person does not have the duty to eliminate all risks of injury of participation in farm animal activities. There are inherent risks of injury that you voluntarily accept if you participate in farm animal activities."

WARNING Under Louisiana Law an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to R.S. 9:2795.3

WARNING Under Maine Law an equine professional has limited liability for an injury or death resulting from the inherent risks of equine activities.

Warning: Under Massachusetts Law an equine professional is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities, pursuant to section 2D of chapter 128 of the General Laws.

WARNING: Under the Michigan Equine Activity Liability Act an equine professional is not liable for an injury to or the death of a participant in an equine activity resulting from an inherent risk of the equine activity.

WARNING: Under Mississippi law, an equine or livestock activity sponsor or an equine or livestock professional is not liable for an injury to or the death of a participant in equine activities or livestock shows resulting from the inherent risks of equine activities or livestock shows, pursuant to this chapter.

WARNING: Under Missouri Law an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities pursuant to the Revised Statutes of Missouri.

WARNING: Under New Hampshire Law an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities.

WARNING: Under New Jersey Law an equestrian area operator is not liable for an injury to or the death of a participant in equine animal activities resulting from the inherent risks of equine animal activities, pursuant to P.L. 1997, c.287 (c.5:15-1 et seq.).

WARNING: Under New Mexico Law an equine professional or equine activity sponsor is not liable for an injury to or the death of a participant in equine activities resulting from equine behavior, including the propensity of an equine animal to kick, bite, shy, buck, stumble, bolt, rear, trample, be unpredictable or collide with other animals, objects or persons.

Pursuant to New York Law ( NY CLS Veh and Tr Section 1265): No person less than eighteen years of age shall ride a horse unless such person is wearing a helmet meeting or exceeding ASTM F1163 (Safety Equipment Institute certified) Equestrian Standard. For purposes of this section, "certified" shall mean that the helmet's manufacturer agrees to the rules and provisions of a system that includes independent testing and quality control audits, and that each helmet manufactured by such manufacturer is permanently marked with the certifying body's registered mark or logo before such helmet is sold or offered for sale. For the purposes of this section, wearing a helmet means having a helmet fastened securely upon the head using the manufacturer's fitting guidelines for the particular model used.

WARNING: Under North Carolina law an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting exclusively from the inherent risks of equine activities. Chapter 99E of the North Carolina General Statutes.

WARNING: Under Ohio Law, R.C. 2305.321 an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, which such risks include: (a) the propensity of an equine to behave in ways that may result in injury, death, or loss to persons on or around the equine; (b) The unpredictability of an equine's reaction to sounds, sudden movement, unfamiliar objects, persons, or other animals; (c) Hazards, including, but not limited to, surface or subsurface conditions; (d) A collision with another equine, another animal, a person, or an object; (e) The potential of an equine activity participant to act in a negligent manner that may contribute to injury, death, or loss to the person of the participant or to other persons, including, but not limited to, failing to maintain control over an equine or failing to act within the ability of the participant.

WARNING: Pursuant to the Oklahoma Livestock Activities Liability Limitation Act, livestock activity sponsors and participants and livestock professionals acting in good faith and pursuant to the standards of the livestock industry shall not be liable for injuries to any person engaged in livestock activities (like horseback riding) when such injuries result from the inherent risks of livestock activities.

WARNING: Under Pennsylvania Law you assume the risk of equine activities pursuant to Pennsylvania law.

WARNING: Under Rhode Island Law an equine professional, unless he or she can be shown to have failed to be in the exercise of due care, is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities, pursuant to this chapter, Rhode Island General Laws, Title 4, Section 4-21-1, et. seq.

WARNING: Under South Carolina law an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in an equine activity resulting from an inherent risk of equine activity pursuant to Article 7, Chapter 9 of Title 47, Code of the Laws of South Carolina, 1976.

WARNING: Under Tennessee Law, an equine professional is not liable for an injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to Tennessee Code Annotated, Title 44, Chapter 20.

WARNING: Under Texas Law (Chapter 87, Civil Practice and Remedies Code), equine professionals and livestock show sponsors are not liable for an injury to or the death of a participant in equine activities or livestock shows resulting from the inherent risks of equine activities of livestock shows.

WARNING; Under Utah Law an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in an equine activity resulting from an inherent risk of equine activity, including (a) the propensity of the animal to behave in ways that may result in injury, harm, or death to persons on or around them;
(b) the unpredictability of the animal's reaction to outside stimulation such as sounds, sudden movement, and unfamiliar objects, persons, or other animals;
(c) collisions with other animals or objects; or (d) the potential of a participant to act in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the animal or not acting within his or her ability.

WARNING: Under Vermont Law an equine activity sponsor is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities that are obvious and necessary, pursuant to 12 V.S.A. § 1039.

Pursuant to Virginia Law (Va. Code. Ann 3.2-6200, et seq.) an equine activity sponsor or equine professional is not liable for an injury to or the death of a participant in an equine activity resulting from an inherent risk of equine activity; inherent risks of equine activities include those dangers or conditions that are an integral part of equine activities, including, but not limited to: (i) the propensity of equines to behave in ways that may result in injury, harm, or death to persons on or around them; (ii) the unpredictability of an equine's reaction to such things as sounds, sudden movement, and unfamiliar objects, persons, or other animals; (iii) certain hazards such as surface and subsurface conditions; (iv) collisions with other animals or objects; and (v) the potential of a participant acting in a negligent manner that may contribute to injury to the participant or others, such as failing to maintain control over the equine or not acting within the participant's ability.

Pursuant to West Virginia Law (TITLE 20, CHAPTER 4) It is recognized that equestrian activities are hazardous to participants, regardless of all feasible safety measures which can be taken. Each participant in an equestrian activity expressly assumes the risk of and legal responsibility for any injury, loss or damage to person or property which results from participation in an equestrian activity. Each participant shall have the sole individual responsibility for knowing the range of his or her own ability to manage, care for, and control a particular horse or perform a particular equestrian activity, and it shall be the duty of each participant to act within the limits of the participant's own ability, to maintain reasonable control of the particular horse or horses at all times while participating in an equestrian activity, to heed all posted warnings, to perform equestrian activities only in an area or in facilities designated by the horseman and to refrain from acting in a manner which may cause or contribute to the injury of anyone. If while actually riding in an equestrian event, any participant collides with any object or person, except an obviously intoxicated person of whom the horseman is aware, or if the participant falls from the horse or from a horse-drawn conveyance, the responsibility for such collision or fall shall be solely that of the participant or participants involved and not that of the horseman.

The following sections apply to ALL riders in ALL States:
Any participant shall be liable for injury, loss or damage resulting from violations of the duties set forth above. Further, a participant involved in an accident shall not depart from the area or facility where the equestrian activity took place without leaving personal identification, including name and address, without notifying the proper authorities, and without obtaining assistance when that person knows or reasonably should know that any other person involved in the accident is in need of medical or other assistance.

By signing this Waiver the undersigned persons specifically represent that he/she; a) is the actual, proper and authorized persons to sign this form; b) understand and acknowledges that he/she is fully responsible for all damages, injuries, death or claims arising from the inherent risks of horseback riding, horse related riding competitions, being around horses in general and acknowledges that he/she waives any and all claims arising from the inherent risks of the activity and/or the ordinary negligence of the IEA Group; c) agree to indemnify (stand in the shoes of), pay and hold harmless the IEA Group from all awards, judgments, costs expenses and attorney fees associated with or arising from any claims or litigation that may arise from or are related to the rider's participation in any IEA Events or activity; and d) unconditionally promise not to sue or maintain any legal action against, or attempt to make any recovery from, the IEA Group in any civil litigation, mediation, arbitration or alternative dispute resolution proceedings.

The undersigned persons acknowledge that in consideration for the signing of this application, acknowledgment and waiver, (1) the undersigned receive the aesthetic pleasure, exercise, education and enjoyment that horseback riding, equestrian competitions and being around horses in general have to offer, and (2) the applicant/rider will be permitted to participate in IEA sanctioned or sponsored events or shows for one full calendar year starting July 1st.

Special Notice to Western Riders and Parents/Guardians of Western Riders:
Western IEA riders have the absolute right to wear safety helmets in IEA competitions without any judging penalty. If the parents or guardians of a Western rider under the age of eighteen allow the rider to ride without a safety helmet then the parents and guardians for themselves and for their rider legally are waiving this right to wear a safety helmet, and are knowingly doing so with the full awareness of the risks of harm, injury or death to the rider.

Youth Sports Organization Concussion Form:

Ohio Department of Health Concussion Information Sheet
For Youth Sports Organizations

Dear Parent/Guardian and Athletes,

This information sheet is provided to assist you and your child in recognizing the signs and symptoms of a concussion. Every athlete is different and responds to a brain injury differently, so seek medical attention if you suspect your child has a concus- sion. Once a concussion occurs, it is very important your athlete return to normal activities slowly, so he/she does not do more damage to his/her brain.

What is a Concussion?

A concussion is an injury to the brain that may be caused by a blow, bump, or jolt to the head. Concussions may also happen after a fall or hit that jars the brain. A blow elsewhere on the body can cause a concussion even if an athlete does not hit his/her head directly. Concussions can range from mild to severe, and athletes can get a concussion even if they are wearing a helmet.

Signs and Symptoms of a Concussion

Athletes do not have to be "knocked out" to have a concussion. In fact, less than 1 out of 10 concussions result in loss of consciousness. Concussion symptoms can develop right away or up to 48 hours after the injury. Ignoring any signs or symptoms of a concussion puts your child's health at risk!

Signs Observed by Parents of Guardians

  • Appears dazed or stunned.
  • Is confused about assignment or position.
  • Forgets plays.
  • Is unsure of game, score or opponent.
  • Moves clumsily.
  • Answers questions slowly.
  • Loses consciousness (even briefly).
  • Shows behavior or personality changes (irritability, sadness, nervousness, feeling more emotional).
  • Can't recall events before or after hit or fall.

Symptoms Reported by Athlete

  • Any headache or "pressure" in head. (How badly it hurts does not matter.)
  • Nausea or vomiting.
  • Balance problems or dizziness.
  • Double or blurry vision.
  • Sensitivity to light and/or noise
  • Feeling sluggish, hazy, foggy or groggy.
  • Concentration or memory problems.
  • Confusion.
  • Does not "feel right."
  • Trouble falling asleep.
  • Sleeping more or less than usual.

Be Honest

Encourage your athlete to be honest with you, his/her coach and your health care provider about his/her symptoms. Many young athletes get caught up in the moment and/or feel pressured to return to sports before they are ready. It is better to miss one game than the entire season... or risk permanent damage!

 

Seek Medical Attention Right Away

Seeking medical attention is an important first step if you suspect or are told your child has a concussion. A qualified health care professional will be able to determine how serious the concussion is and when it is safe for your child to return to sports and other daily activities.

  • No athlete should return to activity on the same day he/she gets a concussion.
  • Athletes should NEVER return to practices/games if they still have ANY symptoms.
  • Parents and coaches should never pressure any athlete to return to play.

The Dangers of Returning Too Soon

Returning to play too early may cause Second Impact Syndrome (SIS) or Post-Concussion Syndrome (PCS). SIS occurs when a second blow to the head happens before an athlete has completely recovered from a concussion. This second impact causes the brain to swell, possibly resulting in brain damage, paralysis, and even death. PCS can occur after a second impact. PCS can result in permanent, long-term concussion symptoms. The risk of SIS and PCS is the reason why no athlete should be allowed to participate in any physical activity before they are cleared by a qualified health care professional.

Recovery

A concussion can affect school, work, and sports. Along with coaches and teachers, the school nurse, athletic trainer, employer, and other school administrators should be aware of the athlete's injury and their roles in helping the child recover.

During the recovery time after a concussion, physical and mental rest are required. A concussion upsets the way the brain normally works and causes it to work longer and harder to complete even simple tasks. Activities that require concentration and focus may make symptoms worse and cause the brain to heal slower. Studies show that children's brains take several weeks to heal following a concussion.

Ohio Dept. of Health | Ohio Injury Prevention Partnership

www.healthyohioprogram.org/concussion


Returning to Daily Activities

  1. Be sure your child gets plenty of rest and enough sleep at night – no late nights. Keep the same bedtime weekdays and weekends.
  2. Encourage daytime naps or rest breaks when your child feels tired or worn-out.
  3. Limit your child's activities that require a lot of thinking or concentration (including social activities, homework, video games, texting, computer, driving, job‐related activities, movies, parties). These activities can slow the brain's recovery.
  4. Limit your child's physical activity, especially those activities where another injury or blow to the head may occur.
  5. Have your qualified health care professional check your child's symptoms at different times to help guide recovery.

Returning to School

  1. Your athlete may need to initially return to school on a limited basis, for example for only half-days, at first. This should be done under the supervision of a qualified health care professional.
  2. Inform teacher(s), school counselor or administrator(s) about the injury and symptoms. School personnel should be instructed to watch for:
    1. Increased problems paying attention.
    2. Increased problems remembering or learning new information.
    3. Longer time needed to complete tasks or assignments.
    4. Greater irritability and decreased ability to cope with stress.
    5. Symptoms worsen (headache, tiredness) when doing schoolwork.
  3. Be sure your child takes multiple breaks during study time and watch for worsening of symptoms.
  4. If your child is still having concussion symptoms, he/ she may need extra help with school‐related activities. As the symptoms decrease during recovery, the extra help or supports can be removed gradually.

Resources

ODH Violence and Injury Prevention Program
www.healthyohioprogram.org/vipp/injury.aspx

Centers for Disease Control and Prevention
www.cdc.gov/Concussion

National Federation of State High School Associations
www.nfhs.org

Brain Injury Association of America
www.biausa.org/

 

Returning to Play

  1. Returning to play is specific for each person, depending on the sport. Starting 4/26/13, Ohio law requires written permission from a health care provider before an athlete can return to play. Follow instructions and guidance provided by ahealthcareprofessional. Itisimportantthatyou,yourchild and your child's coach follow these instructions carefully.
  2. Your child should NEVER return to play if he/she still has ANY symptoms. (Be sure that your child does not have any symptoms at rest and while doing any physical activity and/or activities that require a lot of thinking or concentration).
  3. Be sure that the athletic trainer, coach and physical education teacher are aware of your child's injury and symptoms.
  4. Your athlete should complete a step-by-step exercise -based progression, under the direction of a qualified healthcare professional.
  5. A sample activity progression is listed below. Generally, each step should take no less than 24 hours so that your child's full recovery would take about one week once they have no symptoms at rest and with moderate exercise.*

Sample Activity Progression*

Step 1: Low levels of non-contact physical activity, provided NO SYMPTOMS return during or after activity. (Examples: walking, light jogging, and easy stationary biking for 20‐30 minutes).

Step 2: Moderate, non-contact physical activity, provided NO SYMPTOMS return during or after activity. (Examples: moderate jogging, brief sprint running, moderate stationary biking, light calisthenics, and sport‐ specific drills without contact or collisions for 30‐45 minutes).

Step 3: Heavy, non‐contact physical activity, provided NO SYMPTOMS return during or after activity. (Examples: extensive sprint running, high intensity stationary biking, resistance exercise with machines and free weights, more intense non‐contact sports specific drills, agility training and jumping drills for 45‐60 minutes).

Step 4: Full contact in controlled practice or scrimmage

Step 5: Full contact in game play.

*If any symptoms occur, the athlete should drop back to the previous step and try to progress again after a 24 hour rest period.

Ohio Dept. of Health

Ohio Department of Health
Violence and Injury Prevention Program
246 North High Street, 8th Floor
Columbus, OH 43215
(614) 466-2144

www.healthyohioprogram.org/concussion

Contributing Member Info.

All completed applications will be processed in the order in which they are received. Please allow fifteen business days for processing.

After processing is completed, Contributing Members will receive an emailed link to their member profile providing proof of membership.
Contributing Members must have coach approval to receive administrative privileges to team information and communications.

This membership is open to adult individuals that are not participating in competitions as coaches, but who desire to be members of the association, and to participate fully as members with regard to voting privileges and the right to hold office. A prospective contributing member will fill out an official "Contributing Membership Application", a signed waiver of Liability form and submit dues annually to the association. Contributing Members must ascribe to the Objectives of IEA, remain familiar with all IEA Rules and Regulations, act respectfully at all IEA sanctioned shows, competitions and events, and follow all rules and regulations of the IEA.

Online payment of $50 must accompany this application form.

*
* ,
*
*
*
*
(including area code)
Format: XXX-XXX-XXXX

Application Form Terms & Conditions

Falsification of any membership, show, eligibility or application form may be cause for immediate expulsion of the individual, coach, and/or team from IEA, and any other penalty assessed by the REC or National Steward.

I certify that I have read and understand IEA Rules & Regulations, that I ascribe to the Objectives of IEA, and that I will remain familiar with all IEA Rules and Regulations (and any amendments thereto). I further certify that I will act professionally and respectfully at all IEA sanctioned shows, competitions and events, and follow all rules and regulations of the IEA.

I further affirm that all information on this application is correct and true to the best of my knowledge and belief.

By signing below I acknowledge and certify that before signing this document I have carefully read and fully understand and agree with the contents of all four (4) pages of the IEA INHERENTLY DANGEROUS ACTIVITY ACKNOWLEDGEMENT & WAIVER OF LIABILITY FORM, and two (2) pages of the Concussion Information Sheet that preceded this page.

IMPORTANT: Attached hereto and incorporated herein is a Concussion Information Sheet. Each person signing herein below acknowledges receipt and review of the attached concussion information sheet.

[Note: The spouse of a member cannot be the witness for the member.]


Clear Form